Prognosis has dramatically improved since the combination of CYC and GC has been utilized for severe disease presentations. Milder forms of WG, in which critical organ systems are not involved, may be effectively treated with weekly MTX or daily AZA. Recent studies have demonstrated that in severe disease, making a transition from CYC to MTX or AZA after approximately three months spares, or markedly reduces, CYC toxicities. These include cystitis, bladder cancer, lymphoma, myelodysplasia, and sterility. Almost all patients will achieve remission with these approaches to therapy. Because relapses are very common, patients should be closely monitored for early signs and symptoms of disease, so that treatment may be instituted or changed without delay.
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