Cyrielle Parmentier1,2,3, Jean-Daniel Delbet1,3, Stéphane Decramer4, Olivia Boyer5, Julien Hogan6, Tim Ulinski7,8,9. 1. Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012, Paris, France. 2. Sorbonne University, Paris, France. 3. Inflammation-Immunopathology-Biotherapy, DHU i2b, Paris, France. 4. Pediatric Nephrology and Rheumatology, CHU, Toulouse, France. 5. Pediatric Nephrology Unit, Necker Hospital, APHP, Paris, France. 6. Pediatric Nephrology Unit, Robert-Debré Hospital, APHP, Paris, France. 7. Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012, Paris, France. tim.ulinski@aphp.fr. 8. Sorbonne University, Paris, France. tim.ulinski@aphp.fr. 9. Inflammation-Immunopathology-Biotherapy, DHU i2b, Paris, France. tim.ulinski@aphp.fr.
Abstract
BACKGROUND: Rituximab (RTX) is efficient in steroid-dependent nephrotic syndrome (SDNS) in pediatric and adult patients. The aim of this study is to describe hypogammaglobulinemia as a side effect of RTX treatment. METHODS: All pediatric patients (< 18 years old) of four French pediatric nephrology centers who received RTX for SDNS between 2010 and 2015 have been included. Clinical and biological data have been analyzed retrospectively before, during, and after RTX treatment. Hypogammaglobulinemia was defined as an IgG level < - 2 standard deviations for patient age. RESULTS: A total of 107 pediatric patients have been included, 65.9% were boys, median age at nephrotic syndrome diagnosis was 3.1 interquartile range [IQ 2.24-5.45] years and age at RTX introduction was 11.7 [IQ 8.6-14.2] years. Twenty-one patients had hypogammaglobulinemia before the initiation of RTX. Of the patients, 25/86 had at least one hypogammaglobulinemia during B cell depletion or after B cell recovery while IgG levels at initiation were normal with a persisting hypogammaglobulinemia for 13 patients 1 year after B cell recovery. Patients who developed hypogammaglobulinemia were younger at RTX initiation with a median age of 8.2 years [IQ 6.3-12.4]. Among all the 46 patients with hypogammaglobulinemia during follow-up, 13 had a concomitant infection. CONCLUSIONS: Hypogammaglobulinemia is a frequent complication of RTX treatment in younger children treated for SDNS. The use of RTX in children has to be carefully evaluated and their clinical and biological follow-up should be adapted to the age-dependent risk profile for hypogammaglobulinemia.
BACKGROUND: Rituximab (RTX) is efficient in steroid-dependent nephrotic syndrome (SDNS) in pediatric and adult patients. The aim of this study is to describe hypogammaglobulinemia as a side effect of RTX treatment. METHODS: All pediatric patients (< 18 years old) of four French pediatric nephrology centers who received RTX for SDNS between 2010 and 2015 have been included. Clinical and biological data have been analyzed retrospectively before, during, and after RTX treatment. Hypogammaglobulinemia was defined as an IgG level < - 2 standard deviations for patient age. RESULTS: A total of 107 pediatric patients have been included, 65.9% were boys, median age at nephrotic syndrome diagnosis was 3.1 interquartile range [IQ 2.24-5.45] years and age at RTX introduction was 11.7 [IQ 8.6-14.2] years. Twenty-one patients had hypogammaglobulinemia before the initiation of RTX. Of the patients, 25/86 had at least one hypogammaglobulinemia during B cell depletion or after B cell recovery while IgG levels at initiation were normal with a persisting hypogammaglobulinemia for 13 patients 1 year after B cell recovery. Patients who developed hypogammaglobulinemia were younger at RTX initiation with a median age of 8.2 years [IQ 6.3-12.4]. Among all the 46 patients with hypogammaglobulinemia during follow-up, 13 had a concomitant infection. CONCLUSIONS:Hypogammaglobulinemia is a frequent complication of RTX treatment in younger children treated for SDNS. The use of RTX in children has to be carefully evaluated and their clinical and biological follow-up should be adapted to the age-dependent risk profile for hypogammaglobulinemia.
Authors: Darren M Roberts; Rachel B Jones; Rona M Smith; Federico Alberici; Dinakantha S Kumaratne; Stella Burns; David R W Jayne Journal: J Autoimmun Date: 2014-12-31 Impact factor: 7.094
Authors: Marko Kavcic; Brian T Fisher; Alix E Seif; Yimei Li; Yuan-Shung Huang; Dana Walker; Richard Aplenc Journal: J Pediatr Date: 2012-12-24 Impact factor: 4.406