Efficacy of combined rituximab and daratumumab treatment in posttransplant recurrent focal segmental glomerulosclerosis.
In a series of 5 patients with early post-transplant FSGS recurrence resistant to plasma exchange and rituximab, combined rituximab plus daratumumab induced a complete response in all cases and was well tolerated.
Background
Focal segmental glomerulosclerosis (FSGS) is a leading cause of kidney failure and recurs frequently after kidney transplant, where recurrence worsens the risk of graft failure. Standard therapies — mostly plasma exchange and rituximab — have variable efficacy.
Study design
The report describes 5 cases of early FSGS recurrence after kidney transplant, all negative for genetic FSGS, that were resistant to plasma exchange and rituximab and then treated with combined rituximab and daratumumab. Comprehensive flow cytometry was performed in 2 subjects.
Key findings
The combined treatment induced a complete response in all 5 cases and was well tolerated. Flow cytometry analysis in 2 subjects suggested a mechanistic link between plasma cells and disease activity.
Clinical implications
Given the lack of viable treatments for recurrent FSGS, these uncontrolled case reports support the rationale for a pilot trial testing the safety and efficacy of combined rituximab and daratumumab in post-transplant FSGS recurrence.
Category
Transplant
Source
Am J Transplant
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