Rituximab treatment for severe steroid- or cyclosporine-dependent nephrotic syndrome: a multicentric series of 22 cases

Springer Science and Business Media LLC - Tập 23 - Trang 1269-1279 - 2008
Vincent Guigonis1, Aymeric Dallocchio1, Véronique Baudouin2, Maud Dehennault3, Caroline Hachon-Le Camus4, Mickael Afanetti5, Jaap Groothoff6, Brigitte Llanas7, Patrick Niaudet8, Hubert Nivet9, Natacha Raynaud10, Sophie Taque11, Pierre Ronco12, François Bouissou4,13
1Department of Pediatrics, Centre de référence des maladies rénales rares du Sud-Ouest, Hôpital de la mère et de l’enfant, Limoges, France
2Pediatric Nephrology, Hôpital Robert Debré, Paris, France
3Pediatric Nephrology, Hôpital Jeanne de Flandres, Lille, France
4Centre de référence des maladies rénales rares du Sud-Ouest, Pediatric Nephrology, Hôpital Purpan, Toulouse, France
5Pediatric Nephrology, Hôpital l’Archet II, Nice, France
6Pediatric Nephrology, Emma Children’s Hospital, Amsterdam, The Netherlands
7Pediatric Nephrology, Centre de référence des maladies rénales rares du Sud-Ouest, Hôpital Pellegrin, Bordeaux, France
8Pediatric Nephrology, Hôpital Necker Enfants Malades, Paris, France
9Pediatric Nephrology, Hôpital Clocheville, Tours, France
10Pediatric Nephrology, Hôpital F Guyon, La Réunion, France
11Pediatric Nephrology, Hôpital de Pontchaillou, Rennes, France
12Department of Nephrology, INSERM, UMR S 702, UPMC Univ Paris 06, Hôpital Tenon, AP-HP, Paris, France
13Centre de référence des maladies révales rares du Sud-Quest, Toulouse, France

Tóm tắt

Several case reports suggest that rituximab (RTX) could be effective in steroid-dependent nephrotic syndrome, but RTX efficacy has not yet been studied in a series of patients. Safety and efficacy of RTX were assessed in a multicenter series of 22 patients aged 6.3–22 years with severe steroid-dependent nephrotic syndrome or steroid-resistant but cyclosporin-sensitive idiopathic nephrotic syndrome. Patients were treated with two to four infusions of RTX. Seven patients were nephrotic at the time of RTX treatment. Peripheral B cells were depleted in all subjects. Remission was induced in three of the seven proteinuric patients. One or more immunosuppressive (IS) treatments could be withdrawn in 19 patients (85%), with no relapse of proteinuria and without increasing other IS drugs. RTX was effective in all patients when administered during a proteinuria-free period in association with other IS agents. When relapses occurred, they were always associated with an increase in CD19 cell count. Adverse effects were observed in 45% of cases, but most of them were mild and transient. This study suggests that RTX could be an effective treatment for severe steroid-dependent nephrotic syndrome.

Tài liệu tham khảo

Niaudet P (2004) Steroid-sensitive idiopathic nephrotic syndrome in children. In: Avner E, Harmon W, Niaudet P (eds) Pediatric Nephrology, 5th ed. Lippincot Williams & Wilkins, Philadelphia, pp 543–556 Fakhouri F, Bocquet N, Taupin P, Presne C, Gagnadoux MF, Landais P, Lesavre P, Chauveau D, Knebelmann B, Broyer M, Grunfeld JP, Niaudet P (2003) Steroid-sensitive nephrotic syndrome: from childhood to adulthood. Am J Kidney Dis 41:550–557 British Association for Paediatric Nephrology (1991) Levamisole for corticosteroid-dependent nephrotic syndrome in childhood. British Association for Paediatric Nephrology. Lancet 337:1555–1557 Niaudet P (1992) Comparison of cyclosporin and chlorambucil in the treatment of steroid-dependent idiopathic nephrotic syndrome: a multicentre randomized controlled trial. The French Society of Paediatric Nephrology. Pediatr Nephrol 6:1–3 Bagga A, Hari P, Moudgil A, Jordan SC (2003) Mycophenolate mofetil and prednisolone therapy in children with steroid-dependent nephrotic syndrome. Am J Kidney Dis 42:1114–1120 Report of Arbeitsgemeinschaft fur Pädiatrische Nephrologie (1987) Cyclophosphamide treatment of steroid dependent nephrotic syndrome: comparison of eight week with 12 week course. Report of Arbeitsgemeinschaft fur Padiatrische Nephrologie. Arch Dis Child 62:1102–1106 Dötsch J, Müller-Wiefel DE, Kemper MJ (2008) Rituximab: is replacement of cyclophosphamide and calcineurin inhibitors in steroid-dependent nephrotic syndrome possible? Pediatr Nephrol 23:3–7 Benz K, Dötsch J, Rascher W, Stachel D (2004) Change of the course of steroid-dependent nephrotic syndrome after rituximab therapy. Pediatr Nephrol 19:794–797 Pescovitz MD, Book BK, Sidner RA (2006) Resolution of recurrent focal segmental glomerulosclerosis proteinuria after rituximab treatment. N Engl J Med 354:1961–1963 Nozu K, Iijima K, Fujisawa M, Nakagawa A, Yoshikawa N, Matsuo M (2005) Rituximab treatment for posttransplant lymphoproliferative disorder (PTLD) induces complete remission of recurrent nephrotic syndrome. Pediatr Nephrol 20:1660–1663 Bagga A, Sinha A, Moudgil A (2007) Rituximab in patients with the steroid-resistant nephrotic syndrome. N Engl J Med 356:2751–2752 Francois H, Daugas E, Bensman A, Ronco P (2007) Unexpected efficacy of rituximab in multirelapsing minimal change nephrotic syndrome in the adult: first case report and pathophysiological considerations. Am J Kidney Dis 49:158–161 Gilbert RD, Hulse E, Rigden S (2006) Rituximab therapy for steroid-dependent minimal change nephrotic syndrome. Pediatr Nephrol 21:1698–1700 Hofstra JM, Deegens JK, Wetzels JF (2007) Rituximab: effective treatment for severe steroid-dependent minimal change nephrotic syndrome? Nephrol Dial Transplant 22:2100–2102 Nakayama M, Kamei K, Nozu K, Matsuoka K, Nakagawa A, Sako M, Iijima K (2008) Rituximab for refractory focal segmental glomerulosclerosis. Pediatr Nephrol 23:481–485 Smith GC (2007) Is there a role for rituximab in the treatment of idiopathic childhood nephrotic syndrome? Pediatr Nephrol 22:893–898 Yang T, Nast CC, Vo A, Jordan SC (2008) Rapid remission of steroid and mycophenolate mofetil (MMF) resistant minimal change nephrotic syndrome after rituximab therapy. Nephrol Dial Transplant 23:377–380 Gossmann J, Scheuermann EH, Porubsky S, Kachel HG, Geiger H, Hauser IA (2007) Abrogation of nephrotic proteinuria by rituximab treatment in a renal transplant patient with relapsed focal segmental glomerulosclerosis. Transpl Int 20:558–562 Hristea D, Hadaya K, Marangon N, Buhler L, Villard J, Morel P, Martin PY (2007) Successful treatment of recurrent focal segmental glomerulosclerosis after kidney transplantation by plasmapheresis and rituximab. Transpl Int 20:102–105 Kamar N, Faguer S, Esposito L, Guitard J, Nogier MB, Durand D, Rostaing L (2007) Treatment of focal segmental glomerular sclerosis with rituximab: 2 case reports. Clin Nephrol 67:250–254 Yabu JM, Ho B, Scandling JD, Vincenti F (2008) Rituximab Failed to Improve Nephrotic Syndrome in Renal Transplant Patients With Recurrent Focal Segmental Glomerulosclerosis. Am J Transplant 8:222–227 Berard E, Broyer M, Dehennault M, Dumas R, Eckart P, Fischbach M, Loirat C, Martinat L, Pediatric Society of Nephrology (2005) Corticosensitive nephrotic syndrome (or nephrosis) in children. Therapeutic guideline proposed by the Pediatric Society of Nephrology. Nephrol Ther 1:150–156 Meyer TN, Thaiss F, Stahl RA (2007) Immunoadsorption and rituximab therapy in a second living-related kidney transplant patient with recurrent focal segmental glomerulosclerosis. Transpl Int 20:1066–1071 El-Firjani A, Hoar S, Karpinski J, Bell R, Deschenes MJ, Knoll GA (2008) Post-transplant focal segmental glomerulosclerosis refractory to plasmapheresis and rituximab therapy. Nephrol Dial Transplant 23:425 Marks SD, McGraw M (2007) Does rituximab treat recurrent focal segmental glomerulosclerosis post-renal transplantation? Pediatr Nephrol 22:158–160 Fervenza FC, Cosio FG, Erickson SB, Specks U, Herzenberg AM, Dillon JJ, Leung N, Cohen IM, Wochos DN, Bergstralh E, Hladunewich M, Cattran DC (2008) Rituximab treatment of idiopathic membranous nephropathy. Kidney Int 73:117–125 Kimby E (2005) Tolerability and safety of rituximab (MabThera). Cancer Treat Rev 31:456–473 Kolstad A, Holte H, Fossa A, Lauritzsen GF, Gaustad P, Torfoss D (2007) Pneumocystis jirovecii pneumonia in B-cell lymphoma patients treated with the rituximab-CHOEP-14 regimen. Haematologica 92:139–140 Motto DG, Williams JA, Boxer LA (2002) Rituximab for refractory childhood autoimmune hemolytic anemia. Isr Med Assoc J 4:1006–1008 Freim Wahl SG, Folvik MR, Torp SH (2007) Progressive multifocal leukoencephalopathy in a lymphoma patient with complete remission after treatment with cytostatics and rituximab: case report and review of the literature. Clin Neuropathol 26:68–73 Dantal J, Bigot E, Bogers W, Testa A, Kriaa F, Jacques Y, Hurault de Ligny B, Niaudet P, Charpentier B, Soulillou JP (1994) Effect of plasma protein adsorption on protein excretion in kidney-transplant recipients with recurrent nephrotic syndrome. N Engl J Med 330:7–14 Dantal J, Godfrin Y, Koll R, Perretto S, Naulet J, Bouhours JF, Soulillou JP (1998) Antihuman immunoglobulin affinity immunoadsorption strongly decreases proteinuria in patients with relapsing nephrotic syndrome. J Am Soc Nephrol 9:1709–1715 Habib R, Girardin E, Gagnadoux MF, Hinglais N, Levy M, Broyer M (1988) Immunopathological findings in idiopathic nephrosis: clinical significance of glomerular “immune deposits”. Pediatr Nephrol 2:402–408 Hultin LE, Hausner MA, Hultin PM, Giorgi JV (1993) CD20 (pan-B cell) antigen is expressed at a low level on a subpopulation of human T lymphocytes. Cytometry 14:196–204 Sahali D, Pawlak A, Le Gouvello S, Lang P, Valanciute A, Remy P, Loirat C, Niaudet P, Bensman A, Guellaen G (2001) Transcriptional and post-transcriptional alterations of I kappa B alpha in active minimal-change nephrotic syndrome. J Am Soc Nephrol 12:1648–1658 Mansour H, Cheval L, Elalouf JM, Aude JC, Alyanakian MA, Mougenot B, Doucet A, Deschenes G (2005) T-cell transcriptome analysis points up a thymic disorder in idiopathic nephrotic syndrome. Kidney Int 67:2168–2177 Jazirehi AR, Huerta-Yepez S, Cheng G, Bonavida B (2005) Rituximab (chimeric anti-CD20 monoclonal antibody) inhibits the constitutive nuclear factor-{kappa}B signaling pathway in non-Hodgkin’s lymphoma B-cell lines: role in sensitization to chemotherapeutic drug-induced apoptosis. Cancer Res 65:264–276