Therapeutic effect of vincristine on steroiddependent nephrotic syndrome
YIN Lei, Harley Robert POWELL, ZHOU Wei
Department of Pediatrics, Shanghai Children's Medical Center, Xinhua Hospital, Shanghai Second Medical University, Shanghai 200127, China. Email: yinleik@online.sh.cn
Abstract：OBJECTIVE: The treatment of steroid-dependent nephrotic syndrome (SDNS) remains a challenge.This study evaluated the efficacy of vincristine(VCR) in children with SDNS who had relapses after cyclophosphamide treatment. METHODS: The clinical data of 14 children with SDNS between June 2000 and March 2003 were studied retrospectively. They had relapses after more than one course of cyclophosphamide treatment before VCR treatment.VCR was administered by intravenous boluses in a dose of (1.0-1.5) mg/m~2 once weekly for 4 weeks then once monthly for 4 months. RESULTS: Thirteen patients completed the full course of VCR treatment and one patient discontinued after 6 times of VCR injection because of frequent relapses during the VCR treatment.Six of the 8 patients in relapse achieved complete remission after 2-3 times of VCR injection. After completing the full course of VCR treatment,12 patients achieved remission. Four remained in remission for the median time of 13.5 months (range 9-40 months). Seven of the 8 patients who continued to relapse received another VCR treatment (1 mg/m~2). After 1 or 2 infusions of VCR their proteinuria disappeared. Compared with before VCR treatment, the relapse frequency in half a year post-VCR treatment was decreased from 1.67 to 0.67 time (P<0.05). Side effects related to VCR treatment were uncommon. Only 3 patients presented with abdominal pain, but the symptom was alleviated after the dosage was reduced from 1.5 mg/m~2 to 1.0 mg/m~2. CONCLUSIONS: VCR treatment can induce complete remission of relapse and decrease the relapse frequency in children with SDNS.A few additional doses of VCR infusions may be effective in patients after a full course of VCR treatment but continue to relapse later.
