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Cyclophosphamide compared to ifosfamide for the treatment of sarcoma in children and young adults

Sarcomas are tumours that arise from bone and soft tissues. They can occur in all ages. As a result of the introduction of polychemotherapy, the survival of children and young adults with different types of sarcoma has improved dramatically. Alkylating agents, such as cyclophosphamide and ifosfamide, have played a major role in this improvement. However, in the literature there is still no consensus as to which chemotherapeutic agent is more effective. A well‐informed decision on the use of cyclophosphamide and ifosfamide in the treatment of children and young adults diagnosed with a sarcoma should be based on high‐quality evidence on both anti‐tumour efficacy and adverse effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

The effect of the immunosuppressive drug cyclophosphamide in people with multiple sclerosis

MS is a chronic disease of the nervous system affecting young and middle‐aged adults. MS is supposed to be related to the immune system. CFX is an immunosuppressive drug used for various autoimmune diseases. As its use for MS is controversial, the Authors of this review aimed to assess CFX efficacy for patients with progressive MS. Among the pertinent literature, only five studies met the inclusion criteria of minimum methodological quality , with a total of 90 MS patients treated with CFX.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Cyclophosphamide for treating rheumatoid arthritis

This review included 31 patients taking cyclophosphamide and 39 patients taking placebo. Patients taking cyclophosphamide had improved tender and swollen joint scores. Patients receiving placebo were six times more likely to discontinue treatment because of lack of treatment effect than patients receiving cyclophosphamide. Withdrawals from adverse reactions were higher in the cyclophosphamide group. Side effects from cyclophosphamide included hemorrhagic cystitis, nausea, vomiting, leucopenia, thrombocytopenia, alopecia, amenorrhea and herpes zoster infections.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Using steroids and cyclophosphamide together as a treatment for paraquat poisoning

Paraquat is an effective and widely used herbicide but is also a lethal poison. In many developing countries paraquat is widely available and inexpensive, making poisoning prevention difficult. However most of the people who become poisoned from paraquat have taken it as a means of suicide.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Cyclophosphamide versus methylprednisolone for lupus

Researchers in The Cochrane Collaboration conducted a review of the effect of cyclophosphamide for people with central nervous system lupus compared to the usual treatment of methylprednisolone. After searching for all relevant studies, they found one study with 32 people. The study compared people who took cyclophosphamide by IV (intravenous or through a vein) to people who took steroids (methylprednisolone by IV). All people took steroid pills (prednisone) at the beginning of the study and the amount was decreased over the study. The study lasted two years.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Treatment for people with lupus nephritis

Lupus nephritis is an inflammatory condition affecting the kidneys which is caused by systemic lupus erythematosus (SLE), an autoimmune disease that is more common among women. About half of all people with SLE develop lupus nephritis, and of these about 1/10 experience chronic kidney disease or kidney failure. Treatment aims to delay disease progression and achieve remission by stabilising and improving kidney function and minimising side effects. For about the past 30 years, standard treatment for lupus nephritis has focused on a combination of cyclophosphamide (an alkylating agent) and corticosteroids.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

A review of the use of drugs that suppress the immune system (immunosuppressants) in myasthenia gravis.

Myasthenia gravis (MG) is caused by antibodies produced by the immune system that impair the transmission of nerve impulses to muscles. This results in muscle weakness that characteristically fluctuates. About one person in every 10 000 ‐ 50 000 develops MG each year. The natural history of the disorder is typically a series of exacerbations and remissions. Severe attacks can be life‐threatening because of weakness of muscles involved in swallowing causing choking, and chest muscles causing difficulty with breathing. In MG, immunosuppressant drugs act mainly by reducing the production of antibodies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Non‐steroid agents for idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis is a form of progressive lung disease which ultimately leads to death. The cause is unknown, but the disease is characterised by scar tissue in the lungs. This prevents the lungs from working effectively. Standard treatment uses oral corticosteroids in association with immunosuppressors, but there is uncertainty as to whether this treatment is effective. Immunosuppressive agents such as azathioprine and cyclophosphamide have been used to treat the disease because it is thought they might prevent inflammation. The review found 15 high quality trials of non‐steroid drugs tested in idiopathic pulmonary fibrosis patients. Notwithstanding the encouraging results of a first small study included in the first version of this review, the effects of interferon gamma‐1beta, as assessed by combining two subsequent large trials, were disappointing and failed to show an effect on improving survival. Four studies did evaluate pirfenidone, an anti‐fibrotic oral drug, on a large number of patients: although two of these studies have only been presented in conferences,combining the published and unpublished data showed a significant improvement of pirfenidone on progression‐free survival and a small increase in pulmonary function. Current evidence suggests a possible role for pirfenidone in the treatment of idiopathic pulmonary fibrosis, though data on survival are now needed. However, trials with other non‐steroid agents are currently ongoing and new evidence may become available soon.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions for haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura

This review also showed that in patients with typical or diarrhoea associated haemolytic uraemic syndrome, there are no interventions that are superior to supportive therapy which includes control of fluid and electrolyte imbalance, use of dialysis if required, control of hypertension and blood transfusion as required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Interventions for preventing and treating kidney disease in Henoch‐Schönlein Purpura

Henoch‐Schönlein Purpura (HSP) causes inflammation of small blood vessels in children and affects approximately 20/100,000 children annually. Symptoms and signs include a purpuric skin rash (which comprises small spots and larger bruises), abdominal pain, gastrointestinal bleeding, joint pain and swelling, facial swelling and evidence of kidney disease with blood and protein in the urine. Kidney disease occurs in about one third of children with HSP. In the majority this is mild (small amounts of blood in the urine only) and resolves completely but a few children have persistent kidney disease that can progress to kidney failure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions for mucous membrane pemphigoid and epidermolysis bullosa acquisita (rare autoimmune blistering diseases of the skin, eyes and mouth)

Mucous membrane pemphigoid and epidermolysis bullosa acquisita are rare autoimmune blistering diseases of the skin and mucous membranes (eyes and mouth). They can result in scarring, which may lead to disabling and life threatening complications. Treatments include corticosteroids, mycophenolate mofetil and cyclophosphamide to suppress the immune system, and less toxic drugs such as antibiotics. These diseases often progress despite treatment. There is some evidence that mucous membrane pemphigoid involving the eyes may respond better to treatment with cyclophosphamide combined with corticosteroids, compared to treatment with corticosteroids alone. Cyclophosphamide is, however, associated with potentially severe adverse effects. Dapsone may help moderate disease. More research is needed to identify the most effective treatment options.There is not enough reliable evidence about treatments for the rare blistering diseases, mucous membrane pemphigoid and epidermolysis bullosa acquisita.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions for renal vasculitis in adults

Renal vasculitis presents as rapidly progressive glomerulonephritis which is a form of kidney disease that causes damage to the small structures (glomeruli) inside the kidneys that help filter waste and fluids from blood to form urine. The disease leads to a rapid loss of kidney function. Standard suppression of the immune system with steroids and cyclophosphamide is recommended. The aim of this review was to evaluate the benefits and harms of any intervention for the treatment of renal vasculitis. Thirty one studies (2217 patients) were identified. Plasma exchange reduces the risk of end‐stage kidney disease in patients presenting with severe acute kidney failure. The use of pulse cyclophosphamide results in good remission rates but there was an increased risk of relapse. Azathioprine is effective as maintenance therapy once remission has been achieved. Mycophenolate mofetil is equivalent for remission induction than cyclophosphamide. Mycophenolate mofetil has also been tested in maintenance treatment and was found to result in a higher rate of disease relapse. Initial data on rituximab showed equivalent effectiveness to cyclophosphamide. Methotrexate and leflunomide are useful in maintenance therapy but their relative effectiveness are not clearly defined. Treatment with co‐trimoxazole may prevent respiratory infections and relapses but are unlikely to have a major impact on systemic relapses of vasculitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Non‐corticosteroid treatment for nephrotic syndrome in children

Children with nephrotic syndrome lose excessive amounts of protein from their bloodstream into their urine, causing swelling, especially in the face, stomach and legs. The risk of infection also increases because important proteins used by children's immune systems have been lost. Corticosteroid drugs, such as prednisone, can stop protein loss, but often happens again (relapse). Giving children further corticosteroids can lead to poor growth, cataracts, osteoporosis and high blood pressure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Alkylating agents for Waldenstrom's macroglobulinaemia

Waldenstrom's macroglobulinaemia (WM) is an uncommon B‐cell lymphoproliferative disorder characterised by bone marrow infiltration and production of monoclonal immunoglobulin. It is a kind of non‐Hodgkin's lymphoma which can lead to death. Alkylating agents are believed to be effective in treatment of Waldenstrom's macroglobulinaemia for alleviating symptoms and elongating survival time. The review authors found one randomised controlled trial with 92 participants that considered fludarabine was superior to the alkylating agents‐containing regimen for pretreated/relapsed patients with Waldenstrom's macroglobulinaemia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Interventions for idiopathic steroid‐resistant nephrotic syndrome in children

Nephrotic syndrome is a condition where the kidneys leak protein from the blood into the urine. Corticosteroids are used in the first instance to achieve remission. Some children do not respond to this treatment (steroid‐resistant nephrotic syndrome) and other agents such as cyclophosphamide, calcineurin inhibitors (cyclosporin, tacrolimus) or angiotensin‐converting enzyme inhibitors may be used.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Combinations of anti‐cancer drugs to treat high‐risk cancers arising from the placenta, known as high‐risk gestational trophoblastic neoplasia (GTN)

GTN is a cancer that most often arises after a molar pregnancy but can arise after any type of pregnancy. Molar pregnancies occur due to abnormal growth of placental tissue that is usually benign and treated by evacuation of the womb (D&C). However, in less than 10% of molar pregnancies in the UK, the growth remains after D&C and transforms into a cancer (GTN) that needs treatment with anti‐cancer drugs (chemotherapy). GTN can be low‐risk or high‐risk. Anti‐cancer drugs are very effective, especially in low‐risk GTN, which is usually cured with single‐drug treatment. However, high‐risk GTN needs to be treated with combinations of anti‐cancer drugs for the best effect. These drugs can produce toxic side effects that are more likely to occur when used in combination with each other. The most commonly administered drug combination is abbreviated as EMA/CO, which stands for Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Oncovin® (vincristine), but several other combinations are also in use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Bendamustine for patients with slow‐growing lymphoma

Lymphoma is a cancer that originates from cells of the immune system in the lymph nodes, called lymphocytes. Slow‐growing (indolent) lymphoma is a group of lymphomas characterised by slow and continuous growth, a high initial response rate to treatment that target lymphoma cells (chemotherapy or rituximab), but a relapsing and progressive disease course. It includes follicular lymphoma, small lymphocytic lymphoma and chronic lymphocytic leukaemia, mantle cell lymphoma, lymphoplasmacytic lymphoma and marginal zone lymphoma. With current therapy people with advanced‐stage indolent lymphoma will experience relapse of their disease. Bendamustine is a type of chemotherapy that can be given to people with indolent lymphoma.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Interventions for untreated patients with AIDS‐associated non‐Hodgkin's lymphoma

Lymphoma is a cancer of the lymphatic system. There are two general types: Hodgkin's disease (HD) and non‐Hodgkin's lymphoma (NHL). Non‐Hodgkin's lymphoma is the most common AIDS‐defining malignancy in HIV‐infected patients. The most frequent clinical presentations of NHL during AIDS are systemic illness with the compromise of the primary central nervous system and with primary effusion. In people with HIV infection, most lymphomas have originated in an aggressive B‐cell precursor and have a high‐to‐intermediate histology grade. Randomised controlled trials (RCTs) of different interventions for treating AIDS‐associated NHL found unclear evidence for efficacy and safety.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Maintenance chemotherapy for ovarian cancer

Of all the gynaecological cancers, ovarian cancer has the highest death rate and epithelial ovarian cancer accounts for about 90% of all cases. Surgery and six courses of platinum‐based chemotherapy is the standard treatment and 75% of the women may not have any evidence of disease at the end of this treatment. However, 75% of the women who respond to initial treatment will relapse within 18 to 28 months and only 20% to 40% of all women will survive beyond five years.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Comparison of the two international standards of chemotherapy for people with early unfavourable or advanced stage Hodgkin lymphoma

For the treatment of early unfavourable and advanced stage Hodgkin lymphoma (HL) two different international standards are commonly used, either chemotherapy with escalated (intensified) BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) regimen or chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) regimen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

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