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. 2024 Apr 4;9(6):1892-1896.
doi: 10.1016/j.ekir.2024.04.006. eCollection 2024 Jun.

Combined Rituximab and Daratumumab Treatment in Difficult-to-Treat Nephrotic Syndrome Cases

Andrea Angeletti  1 , Sofia Bin  2 , Xhuliana Kajana  1 , Sonia Spinelli  1 , Carolina Bigatti  1 , Gianluca Caridi  1 , Giovanni Candiano  1 , Francesca Lugani  1 , Enrico E Verrina  1 , Edoardo La Porta  1 , Alberto Magnasco  1 , Maurizio Bruschi  1 , Paolo Cravedi  2 , Gian Marco Ghiggeri  1
Affiliations

Combined Rituximab and Daratumumab Treatment in Difficult-to-Treat Nephrotic Syndrome Cases

Andrea Angeletti et al. Kidney Int Rep. .
No abstract available

Keywords: anti-NEPHRIN antibodies; daratumumab; focal segmental glomerulosclerosis; minimal change disease; nephrotic syndrome; rituximab.

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Figures

Figure 1
Figure 1
Response to treatment with combined rituximab and daratumumab in multidrug-resistant nephrotic syndrome. (a) Proteinuria and IgM levels before and after combined rituximab + daratumumab in steroid-resistant nephrotic syndrome for each patients. (Patient 3 is a multidrug-resistant nephrotic syndrome, not in therapy at enrolment because, in the 2 years before enrolment, she declined any treatments due to the lack of efficacy. After rituximab and daratumumab treatment, she did not respond and refused further treatments; patient 7 had only 9 months of follow-up). (b) Overall proteinuria and serum albumin. (c) Levels before and after combined rituximab + daratumumab in steroid resistant-nephrotic syndrome. (d) Levels of circulating anti-NEPHRIN antibodies before and 3 months after combined rituximab + daratumumab in 5 patients. (e) QoL index (expressed as percentage, 100 for excellent and 0 for poor) based on questionnaire adapted by Cure GNS2–S4 (for subjects < 12 years, QoL index was based on parents’ responses). Dara, daratumumab; NS, nephrotic syndrome; ProtU, proteinuria; QoL, quality of life; Rtx, rituximab.
Figure 2
Figure 2
Response to treatment with combined rituximab and daratumumab in multidrug-dependent nephrotic syndrome. (a) Relapse-free survival during combined immunosuppressive drugs (MMF, CNI and/or rituximab and/or steroids) (black dot line) versus after combined treatment with rituximab + daratumumab (red line). Immunosuppressive oral drugs were removed after combined treatment. (b) Overall levels of circulating anti-NEPHRIN antibodies before and 3 months after combined rituximab + daratumumab in multidrug-dependent nephrotic syndrome. (c) Changes in CD38+ plasma cells before and after combined rituximab + daratumumab in multidrug-dependent nephrotic syndrome. (d) We performed a contingency analysis between early and late nephrotic syndrome recurrence (< or > 9 months after rituximab + daratumumab treatment, respectively), based on IgM values at 3 months after treatment in 14 of the 20 patients with available data. Low and high IgM values were defined based on IgM value at 3 months after combined infusions (above or below average value of 32 mg/dl). IgM values > 32 mg/dl at 3 months associated with significantly increased risk of early relapse. (e) QoL index (expressed as percentage, 100 for excellent and 0 for poor) based on questionnaire adapted by Cure GNS2–S4 (for subjects < 12 years, QoL index was based on parents’ responses). CNI, calcineurin; Dara, daratumumab; IS, immunosuppressive; MMF, mycophenolate mofetil ;QoL, quality of life; Rtx, rituximab.
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References

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