Jean Daniel Delbet1,2, Gael Leclerc1, Tim Ulinski3,4,5. 1. Pediatric Nephrology, Department of Pediatric Nephrology, Armand Trousseau Hospital, APHP, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France. 2. University Pierre and Marie Curie, Paris 6, Paris, France. 3. Pediatric Nephrology, Department of Pediatric Nephrology, Armand Trousseau Hospital, APHP, 26 Avenue du Docteur Arnold Netter, 75012, Paris, France. tim.ulinski@trs.aphp.fr. 4. University Pierre and Marie Curie, Paris 6, Paris, France. tim.ulinski@trs.aphp.fr. 5. DHU 2iB, Inflammation-Immunotherapy, Paris, France. tim.ulinski@trs.aphp.fr.
Abstract
BACKGROUND: Rituximab (RTX) has been shown to be an efficient treatment for steroid-dependent nephrotic syndrome (SDNS). A long B cell depletion period seems to improve the duration of remission. This study reports the duration of B cell depletion after each RTX infusion in patients with nephrotic syndrome. METHODS: We retrospectively report the data of 22 patients with a diagnosis of a SDNS or steroid-resistant nephrotic syndrome (SRNS) and a treatment with RTX in a single center. B cell depletion duration was compared to the first B cell depletion duration and to the previous B cell depletion duration in each patient. RESULTS: Twenty-two patients (5 girls) were included. Seventy-six periods of B cell depletions were compared to the first B cell depletion duration and to the preceding B cell depletion duration in the same patient. Total duration of B cell depletion was 26 (6-66) months. Individual post-RTX infusion B cell depletion duration was 5.1 (1.6-14) months. Median B cell depletion duration following the first RTX cure for children who had received 1 to 2 infusions at first cure was not statistically different of those who had received 3 to 4 infusions (p = 0.18). Comparing the B cell depletion induced by previous RTX courses and the following B cell depletion, 89.5% of patients had a similar duration within an open interval from 2 months. CONCLUSION: Once the individual time interval until B cell recovery is determined, monitoring could be individualized by targeting the expected date of B cell recovery or by performing pre-emptive RTX injections.
BACKGROUND:Rituximab (RTX) has been shown to be an efficient treatment for steroid-dependent nephrotic syndrome (SDNS). A long B cell depletion period seems to improve the duration of remission. This study reports the duration of B cell depletion after each RTX infusion in patients with nephrotic syndrome. METHODS: We retrospectively report the data of 22 patients with a diagnosis of a SDNS or steroid-resistant nephrotic syndrome (SRNS) and a treatment with RTX in a single center. B cell depletion duration was compared to the first B cell depletion duration and to the previous B cell depletion duration in each patient. RESULTS: Twenty-two patients (5 girls) were included. Seventy-six periods of B cell depletions were compared to the first B cell depletion duration and to the preceding B cell depletion duration in the same patient. Total duration of B cell depletion was 26 (6-66) months. Individual post-RTX infusion B cell depletion duration was 5.1 (1.6-14) months. Median B cell depletion duration following the first RTX cure for children who had received 1 to 2 infusions at first cure was not statistically different of those who had received 3 to 4 infusions (p = 0.18). Comparing the B cell depletion induced by previous RTX courses and the following B cell depletion, 89.5% of patients had a similar duration within an open interval from 2 months. CONCLUSION: Once the individual time interval until B cell recovery is determined, monitoring could be individualized by targeting the expected date of B cell recovery or by performing pre-emptive RTX injections.
Entities:
Keywords:
B cell depletion; Children; Nephrotic syndrome; Rituximab
Authors: Markus J Kemper; Jutta Gellermann; Sandra Habbig; Rafael T Krmar; Katalin Dittrich; Therese Jungraithmayr; Lars Pape; Ludwig Patzer; Heiko Billing; Lutz Weber; Martin Pohl; Katrin Rosenthal; Anne Rosahl; Dirk E Mueller-Wiefel; Jörg Dötsch Journal: Nephrol Dial Transplant Date: 2011-11-09 Impact factor: 5.992