A case of treatment-resistant membranous nephropathy associated with graft versus host disease successfully treated with daratumumab.
daratumumab
graft versus host disease
hematopoietic cell transplantation
membranous nephropathy
nephrotic syndrome
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
revised:
25
01
2022
received:
13
05
2021
accepted:
17
02
2022
pubmed:
7
3
2022
medline:
12
5
2022
entrez:
6
3
2022
Statut:
ppublish
Résumé
Membranous nephropathy (MN) is the most common cause of glomerulopathy after hematopoietic cell transplantation (HCT), most often occurring in the setting of graft versus host disease (GVHD). Twenty percent of patients will fail to respond to standard therapy and may progress to end stage renal disease. Here we present the case of a pediatric patient who developed chronic oral GVHD more than one-year post-HCT, who subsequently developed nephrotic syndrome (anasarca, nephrotic range proteinuria, hypoalbuminemia) and had a renal biopsy consistent with MN. Treated with ibrutinib for her GVHD, and steroids, tacrolimus, and rituximab for her MN, she failed to achieve even partial remission of her kidney disease after 8 months. Due to steroid toxicity and 0% CD19 cells on lymphocyte subpopulation flow cytometry, the decision was made to trial plasma cell depletion therapy with daratumumab. She received three doses of daratumumab at weeks 1, 4, and 17. Her nephrotic syndrome resolved and her serum albumin was greater than 3.0 gm/dl by week 10. She was weaned off of both steroids and tacrolimus by week 16, at which time she had near-complete remission of her renal disease. Daratumumab may be an important, novel therapeutic option for post-HCT MN patients who are not responsive to standard therapies.
Sections du résumé
BACKGROUND
Membranous nephropathy (MN) is the most common cause of glomerulopathy after hematopoietic cell transplantation (HCT), most often occurring in the setting of graft versus host disease (GVHD). Twenty percent of patients will fail to respond to standard therapy and may progress to end stage renal disease. Here we present the case of a pediatric patient who developed chronic oral GVHD more than one-year post-HCT, who subsequently developed nephrotic syndrome (anasarca, nephrotic range proteinuria, hypoalbuminemia) and had a renal biopsy consistent with MN. Treated with ibrutinib for her GVHD, and steroids, tacrolimus, and rituximab for her MN, she failed to achieve even partial remission of her kidney disease after 8 months. Due to steroid toxicity and 0% CD19 cells on lymphocyte subpopulation flow cytometry, the decision was made to trial plasma cell depletion therapy with daratumumab.
METHOD
She received three doses of daratumumab at weeks 1, 4, and 17.
RESULTS
Her nephrotic syndrome resolved and her serum albumin was greater than 3.0 gm/dl by week 10. She was weaned off of both steroids and tacrolimus by week 16, at which time she had near-complete remission of her renal disease.
CONCLUSION
Daratumumab may be an important, novel therapeutic option for post-HCT MN patients who are not responsive to standard therapies.
Substances chimiques
Antibodies, Monoclonal
0
Steroids
0
daratumumab
4Z63YK6E0E
Tacrolimus
WM0HAQ4WNM
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14263Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
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