Idiopathic nephrotic syndrome and rituximab: may we predict circulating B lymphocytes recovery?

• Published in: Pediatric nephrology (Berlin, West) West), 2019-03, Vol.34 (3), p.529-532
• Main Authors: Delbet, Jean Daniel, Leclerc, Gael, Ulinski, Tim
• Format: Article
• Language: English
• Subjects: Adolescent; B-Lymphocytes - drug effects; B-Lymphocytes - immunology; Brief Report; Child; Child, Preschool; Children; Complications and side effects; Dosage and administration; Drug Monitoring - methods; Drug therapy; Female; Humans; Immunologic Factors - administration & dosage; Immunotherapy; Infant; Infusions, Intravenous; Kidney diseases; Lymphocyte Depletion - methods; Lymphocytes B; Male; Medicine; Medicine & Public Health; Monoclonal antibodies; Nephrology; Nephrotic syndrome; Nephrotic Syndrome - blood; Nephrotic Syndrome - drug therapy; Nephrotic Syndrome - immunology; Patients; Pediatrics; Recovery (Medical); Recurrence; Remission; Retrospective Studies; Rituximab; Rituximab - administration & dosage; Secondary Prevention - methods; Time Factors; Treatment Outcome; Urology
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-018-4139-4

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.