Randomized controlled trial of pulse/synchronization cyclophosphamide/apheresis for proliferative lupus nephritis

• Published in: Journal of clinical apheresis Vol. 13; no. 4; pp. 163 - 166
• Main Authors: Wallace, Daniel J., Goldfinger, Dennis, Pepkowitz, Samuel H., Fichman, Marshal, Metzger, Allan L., Schroeder, Johann O., Euler, Hans H.
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 1998; Wiley-Liss
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Component Removal - methods; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Cell Division - drug effects; Combined Modality Therapy; Cyclophosphamide - administration & dosage; cyclophosphamide therapy; Drug Administration Schedule; Female; Humans; Immunosuppressive Agents - administration & dosage; Lupus Nephritis - therapy; Medical sciences; proliferative lupus nephritis; pulse/synchronization apheresis; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Kidney disease; Human; Immunopathology; Connective tissue disease; Skin disease; Proliferative glomerulonephritis; Urinary system disease; Autoimmune disease; Synchronization; Chemotherapy; Cyclophosphamide; Oxazaphosphinane derivatives; Nitrogen mustard; Systemic disease; Lupus erythematosus; Combined treatment; Disseminated; Pulse sequence
• ISSN: 0733-2459; 1098-1101
• DOI: 10.1002/(SICI)1098-1101(1998)13:4<163::AID-JCA4>3.0.CO;2-1

OBJECTIVE
To assess the efficacy of pulse/synchronization cyclophosphamide/apheresis in patients with proliferative lupus nephritis.
METHODS
Eighteen patients with Class III or IV renal biopsies and chronicity indices <6 were prospectively randomized to receive 6 courses of parenteral cyclophosphamide over 8 months along with prednisone. Nine of these patients also received 3 daily plasmaphereses prior to each of the 6 courses of cyclophosphamide. Assessments compiled at 6 and 24 months included serum creatinine, albumin, anti DNA, 24‐hour urine protein, and C3 complement along with SLAM scores.
RESULTS
Two out of nine patients in each group evolved end stage renal disease and 3/9 patients in each group went into a renal remission at 24 months. Serum albumin, C3 complement, and SLAM scores improved in both groups, and anti‐DNA improved in the pulse/synchronization patients (P < 0.025). No intergroup comparisons were significant.
CONCLUSION
The addition of pulse/synchronization apheresis to cyclophosphamide therapy does not improve the course of patients with proliferative lupus nephritis. J. Clin. Apheresis 13:163–166, 1998. © 1998 Wiley‐Liss, Inc.