Cyclophosphamide versus cyclosporine in children with frequent-relapsing and steroid-dependent nephrotic syndrome in Khartoum State, Sudan

Background: in children with frequent-relapsing and steroid-dependent (FR/SD) nephrotic syndrome (NS) remission can be achieved with either cyclophosphamide (CPM) or cyclosporine(CSA). Our objective was to compare the efficacy and safety of these agents.Methodology: Records of all children with FR/SD NS who received CPM or CSA at the Pediatric Renal Unit, Soba Hospital, Khartoum, during the period 2005­2015 were retrospectively reviewed.Main outcomes were: remission rate, relapse rate, and renal outcome.Results: We studied 82 children with FR/SD NS treated with CPM (59.8%) or CSA (40.2%). Males were 69.5% and females 30.5%. The mean admission age was 5 ± 3.10 years. At 6 months,77.6% children on CPM and 60.3% on CSA were in complete remission (CR), (P=0.012) whereas 22.4% versus 39.4% relapsed respectively (P=0.012). At 12 months, 57.5% on CPM and 72.7%on CSA were in CR, (P=0.013) whereas 42.5% versus 27.3% relapsed respectively, (P=0.013). At 24 months, 16.6% on CPM and 29% on CSA were in CR, (P=0.030) whereas 83.4% versus 71%relapsed respectively, (P=0.030). The mean number of relapses per 24 months were 1.7± 0.86 inCPM group versus 2.2 ±0.85 in CSA group, (P=0.72). Mild complications were recorded in 12.4% of patients on CPM group versus 33.3% on CSA, (P=0.031). At the latest follow- up, there was no significant change from basal levels of TWBC, mean serum creatinine, GFR, or BMI, (P>0.05 for all parameters). Conclusion: In children with FR/SD NS, both CPM and CSA were effective and safe in achieving remission with less risk of serious side- effects. However, long-term remission was less stable with both agents

Burkitt Lymphoma: A Potentially Curable Childhood Tumour: Experience in Ile-Ife, Nigeria (1986-2014)

Background: Burkitt lymphoma (BL) is the commonest tumour among Nigerian children. It is reported to be highly responsive to readily available cytotoxic drugs; yet, the outcome of therapy remains abysmal.Objectives: To review the epidemiology of BL in terms of risk factors, age incidence, regional distribution, disease sub-types, examine the available treatment regimens locally and internationally and report on the outcome of treatment in Nigeria under different conditions.Methods: A comprehensive literature review on the epidemiology of BL was undertaken and results of publications and clinical trials of BL were evaluated.Results: Three major sub-types of Burkitt lymphoma are recognised in the world literature; the classic endemic BL (eBL) in sub-Saharan Africa, EBV-independent sporadic BL (sBL) found in population outside the endemic areas and the HIV-related BL (HIV-BL), which is found in regions with high incidence of HIV infection. All the sub-types have common cytogenetic abnormalities: t (8, 14), t (8, 22), and t (2, 8). The COM regimen incorporating cyclophosphamide, oncovin and methotrexate (with the intrathecal cytarabine and methotrexate), was found to be very effective for eBL. Treatment outcome was dismal for the self-financed patients treated with COM regimen between 1986 and 2000 (Group A) compared to the internationally sponsored patients treated between 2000 and 2014 (Group B). While 16.8% of Group A patients had no chemotherapy, 9.8% were lost to toxic deaths and 88% defaulted; most of the patients in group B had full chemotherapy; the Event-Free Survival (EFS) rates at 12 and 24 months were 58.3% and 53.4%, respectively

Le protocole CMA dans le traitement du lymphome de Burkitt africain

Une etude prospective sur la place du protocole cyclophosphamide-methotrexate-Aracytine (CMA) a ete entreprise d'octobre 1994 a fevrier 1999; sur 50 patients. Les resultats enregistres peuvent etre resumes en : remission complete; 76d'une duree moyenne de 24 mois; 5 cas de guerison a 5 ans; des survies allaient de 6 mois a 5 ans. Le pourcentage de deces a ete de 35. Les criteres de bonnes reponses therapeutiques ou protocole CMA; ont aussi ete determine.s