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

Autor:	Randone P; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Sanna E; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Dolla C; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Gallo E; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Mingozzi S; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Tarragoni R; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Torazza MC; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Niarchos A; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Mella A; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Manzione AM; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Barreca A; Pathology Unit, University of Turin, Città Della Salute e Della Scienza, Turin, Italy., Deambrosis I; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Giraudi R; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy., Biancone L; Renal Transplantation Center 'A. Vercellone,' Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, Corso Bramante, Turin, Italy. Electronic address: luigi.biancone@unito.it.
Jazyk:	angličtina
Zdroj:	American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2024 Oct; Vol. 24 (10), pp. 1896-1900. Date of Electronic Publication: 2024 Jul 17.
DOI:	10.1016/j.ajt.2024.06.010
Abstrakt:	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 m 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 + 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. Competing Interests: Declaration of competing interests The authors of this manuscript have no conflicts of interest to disclose as described in the American Journal of Transplantation. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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