The recurrence of primary focal segmental glomerulosclerosis (FSGS) after kidney transplantation is associated with a high graft loss rate with standard treatments based on plasmapheresis with/without rituximab. We present 2 consecutive cases of nongenetic early severe recurrent FSGS refractory to rituximab and anti-interleukin 1 treatment and with a partial response to plasmapheresis. Case 1 was a 22-year-old man who was rescue- treated for recurrence 36 weeks after transplantation with obinutuzumab (1000 mg/1.73 m2, 2 , 1 dose) and daratumumab (18 mg/kg each dose, 8 doses), resulting in plasmapheresis discontinuation and a drop of proteinuria from 29 to 2.3 g/d. Proteinuria increased with circulating CD38 & thorn; & thorn; plasma cells and responded to an additional daratumumab dose. Currently, the proteinuria is 1.8 g/d, 14.5 months after discontinuing plasmapheresis and starting obinutuzumab and daratumumab therapy. Case 2 was a 15-year-old girl who was plasmapheresis dependent with 2 g/d proteinuria 82 weeks after transplantation, with a Tesio catheter in the right jugular vein as the only possible vascular access. After treatment with obinutuzumab and daratumumab (1 dose each), she achieved stable complete remission (0.3 g/d proteinuria) with persistent plasmapheresis discontinuation. These cases suggest the potential of combining obinutuzumab with daratumumab for the treatment of recurrent FSGS.

Rescue with obinutuzumab and daratumumab as combined B cell/plasma cell targeting approach in severe posttransplant focal segmental glomerulosclerosis recurrence

Randone, Paolo;Sanna, Enrico;Dolla, Caterina;Gallo, Ester;Mingozzi, Silvia;Tarragoni, Rita;Niarchos, Anna;Mella, Alberto;Barreca, Antonella;Deambrosis, Ilaria;Giraudi, Roberta;Biancone, Luigi
2024-01-01

Abstract

The recurrence of primary focal segmental glomerulosclerosis (FSGS) after kidney transplantation is associated with a high graft loss rate with standard treatments based on plasmapheresis with/without rituximab. We present 2 consecutive cases of nongenetic early severe recurrent FSGS refractory to rituximab and anti-interleukin 1 treatment and with a partial response to plasmapheresis. Case 1 was a 22-year-old man who was rescue- treated for recurrence 36 weeks after transplantation with obinutuzumab (1000 mg/1.73 m2, 2 , 1 dose) and daratumumab (18 mg/kg each dose, 8 doses), resulting in plasmapheresis discontinuation and a drop of proteinuria from 29 to 2.3 g/d. Proteinuria increased with circulating CD38 & thorn; & thorn; plasma cells and responded to an additional daratumumab dose. Currently, the proteinuria is 1.8 g/d, 14.5 months after discontinuing plasmapheresis and starting obinutuzumab and daratumumab therapy. Case 2 was a 15-year-old girl who was plasmapheresis dependent with 2 g/d proteinuria 82 weeks after transplantation, with a Tesio catheter in the right jugular vein as the only possible vascular access. After treatment with obinutuzumab and daratumumab (1 dose each), she achieved stable complete remission (0.3 g/d proteinuria) with persistent plasmapheresis discontinuation. These cases suggest the potential of combining obinutuzumab with daratumumab for the treatment of recurrent FSGS.
2024
Inglese
Esperti anonimi
24
10
1896
1900
5
daratumumab; focal segmental; kidney transplant; obinutuzumab
no
   Incrementare la sopravvivenza del trapianto di rene: identificazione di strategie innovative per il superamento del rigetto cronico
   SopraToR
   FONDAZIONE CRT
   RF=105198/2023.0356

   A retrospective approach to the immune and miRNA profiling in kidney transplant recipients with cancer. - Finanziato dall’Unione europea – Next Generation EU
   miRNA profiling in kidney transplant recipients with cancer
   Ministero dell'Università e della Ricerca
   2022LTXXRP
1 – prodotto con file in versione Open Access (allegherò il file al passo 6 - Carica)
262
14
Randone, Paolo; Sanna, Enrico; Dolla, Caterina; Gallo, Ester; Mingozzi, Silvia; Tarragoni, Rita; Torazza, Maria Cristina; Niarchos, Anna; Mella, Alber...espandi
info:eu-repo/semantics/article
open
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/2029082
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