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Published on: August 12, 2017
Anti-CD38/Anti-CD20 Rescue Therapy for Posttransplant Recurrent FSGS
Juliette Leon1, Elise Ducrocq1, Marie-Camille Lafargue1,2
1Department of Kidney Diseases and Metabolism, Transplantation and Clinical Immunology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, and Université Paris Cité, Paris, France.
Combined plasma cell and B-cell depletion using daratumumab shows promise for treating recurrent focal segmental glomerulosclerosis (rFSGS) post-kidney transplant. This strategy achieved significant remission rates and reduced proteinuria, offering a potential alternative to prolonged apheresis.
Area of Science:
- Nephrology
- Immunology
- Transplantation Medicine
Background:
- Recurrent focal segmental glomerulosclerosis (rFSGS) is a serious post-kidney transplant complication.
- Standard therapies for rFSGS are often ineffective, necessitating prolonged apheresis.
- Limited real-world data exists on combined plasma cell and B-cell depletion for rFSGS.
Purpose of the Study:
- To evaluate the efficacy and safety of daratumumab (anti-CD38) combined with anti-CD20 therapy in kidney transplant recipients with rFSGS.
- To assess clinical response, histological changes, and antinephrin antibody trajectories.
- To provide multicenter real-world data on this treatment strategy.
Main Methods:
- Retrospective study of 17 kidney transplant recipients with rFSGS treated with daratumumab.
- Daratumumab administered after and/or with anti-CD20 therapy across 12 French centers.
- Clinical, biological, and histological data collected at treatment initiation; response and safety assessed longitudinally.
Main Results:
- 41% achieved complete remission (CR) and 24% partial remission (PR) after daratumumab, enabling apheresis discontinuation.
- Median proteinuria decreased significantly from 3.9 g/g to 1.4 g/g at 1 month (P=0.029).
- Treatment was well-tolerated, with dynamic antinephrin antibody changes observed in some patients.
Conclusions:
- Combined plasma cell and B-cell depletion demonstrates meaningful remission rates in refractory rFSGS.
- The treatment is associated with dynamic changes in antinephrin antibodies in select cases.
- Prospective trials are needed to optimize patient selection, dosing, and therapeutic role.
