We describe the long-term follow-up of severe
lupus nephritis treated with
cyclophosphamide, with emphasis on the incidence of relapses after
therapy withdrawal. From a cohort of SLE patients followed over a period of twelve years, we review the charts of the eleven with histologic evidence of class IV
nephritis who reached complete remission with
cyclophosphamide and who were followed for more than four years after the discontinuation. In all patients,
cyclophosphamide was maintained for longer than two years after complete remission. Four patients relapsed following
therapy withdrawal (36%). Sequential biopsies were taken in eight patients after remission or relapse and show a good histologic correlation with clinical renal data. Clinical remission with re-induction
therapy could not be achieved in two patients after relapse. We conclude that relapse is frequently observed following
cyclophosphamide withdrawal in lupus patients with diffuse proliferative
glomerulonephritis initially responsive to this
therapy. Studies are needed to determine the influence of different regimes of maintenance
therapy on the rate of relapses.