Rituximab-associated hypogammaglobulinemia in children with idiopathic nephrotic syndrome: results of an ESPN survey.
Children
Hypogammaglobulinemia
Nephrotic syndrome
Rituximab
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
05
10
2022
accepted:
08
02
2023
revised:
13
01
2023
medline:
17
8
2023
pubmed:
5
4
2023
entrez:
4
4
2023
Statut:
ppublish
Résumé
There is paucity of information on rituximab-associated hypogammaglobulinemia (HGG) and its potential infectious consequences in children treated for idiopathic nephrotic syndrome (INS). A survey was distributed by the European Society Pediatric Nephrology to its members. It addressed the screening and management practices of pediatric nephrology units for recognizing and treating RTX-associated HGG and its morbidity and mortality. Eighty-four centers which had treated an overall 1328 INS children with RTX responded. The majority of centers administered several courses of RTX and continued concomitant immunosuppressive therapy. Sixty-five percent of centers routinely screened children for HGG prior to RTX infusion, 59% during, and 52% following RTX treatment. Forty-seven percent had observed HGG prior to RTX administration, 61% during and 47% >9 months following treatment in 121, 210, and 128 subjects respectively. Thirty-three severe infections were reported among the cohort of 1328 RTX-treated subjects, of whom 3 children died. HGG had been recognized in 30/33 (80%) of them. HGG in steroid-dependent/frequently relapsing nephrotic syndrome (SDNS/FRNS) children is probably multifactorial and can be observed prior to RTX administration in children with SDNS/FRNS. Persistent HGG lasting >9 months from RTX infusion is not uncommon and may increase the risk of severe infections in this cohort. We advocate for the obligatory screening for HGG in children with SDNS/FRNS prior to, during, and following RTX treatment. Further research is necessary to identify risk factors for developing both HGG and severe infections before recommendations are made for its optimal management. A higher resolution version of the Graphical abstract is available as Supplementary information.
Sections du résumé
BACKGROUND
There is paucity of information on rituximab-associated hypogammaglobulinemia (HGG) and its potential infectious consequences in children treated for idiopathic nephrotic syndrome (INS).
METHODS
A survey was distributed by the European Society Pediatric Nephrology to its members. It addressed the screening and management practices of pediatric nephrology units for recognizing and treating RTX-associated HGG and its morbidity and mortality. Eighty-four centers which had treated an overall 1328 INS children with RTX responded.
RESULTS
The majority of centers administered several courses of RTX and continued concomitant immunosuppressive therapy. Sixty-five percent of centers routinely screened children for HGG prior to RTX infusion, 59% during, and 52% following RTX treatment. Forty-seven percent had observed HGG prior to RTX administration, 61% during and 47% >9 months following treatment in 121, 210, and 128 subjects respectively. Thirty-three severe infections were reported among the cohort of 1328 RTX-treated subjects, of whom 3 children died. HGG had been recognized in 30/33 (80%) of them.
CONCLUSIONS
HGG in steroid-dependent/frequently relapsing nephrotic syndrome (SDNS/FRNS) children is probably multifactorial and can be observed prior to RTX administration in children with SDNS/FRNS. Persistent HGG lasting >9 months from RTX infusion is not uncommon and may increase the risk of severe infections in this cohort. We advocate for the obligatory screening for HGG in children with SDNS/FRNS prior to, during, and following RTX treatment. Further research is necessary to identify risk factors for developing both HGG and severe infections before recommendations are made for its optimal management. A higher resolution version of the Graphical abstract is available as Supplementary information.
Identifiants
pubmed: 37014530
doi: 10.1007/s00467-023-05913-1
pii: 10.1007/s00467-023-05913-1
pmc: PMC10432325
doi:
Substances chimiques
Rituximab
4F4X42SYQ6
Immunosuppressive Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3035-3042Investigateurs
H Alpay
(H)
R Andersen
(R)
G Ariceta
(G)
B Atmış
(B)
U S Bayrakçı
(US)
B Esrea
(B)
V Baudouin
(V)
N Bervina
(N)
E Benetti
(E)
E Berard
(E)
A Bjerre
(A)
M Christian
(M)
A Couderc
(A)
J Dehoorne
(J)
G Deschenes
(G)
C Dossier
(C)
R Düşünsel
(R)
Z Ekinci
(Z)
F Emma
(F)
L Espinoza
(L)
A Gianviti
(A)
M Herrero Goñi
(M)
G Guido
(G)
L Ghio
(L)
J Groothoff
(J)
D Ö Hacıhamdioğlu
(DÖ)
M Espino Hernández
(M)
A Jankauskiene
(A)
M Kagan
(M)
M Kemper
(M)
M Kovacevic
(M)
S Kohl
(S)
R T Kramar
(RT)
M López-González
(M)
A M Aris
(AM)
S Maringhini
(S)
M Marlais
(M)
M Melgosa
(M)
A Mitsioni
(A)
G Montini
(G)
A Moczulska
(A)
L Murer
(L)
V Obukhova
(V)
J Oh
(J)
P Ortega
(P)
Z B Özçakar
(ZB)
T Ulinski
(T)
A Pasini
(A)
T Papalia
(T)
S Paunova
(S)
A Pena
(A)
C Pecoraro
(C)
E Petrosyan
(E)
L Peruzzi
(L)
N Printza
(N)
L Prikhodina
(L)
C Pietrement
(C)
S Rittig
(S)
D Rodrigo
(D)
N Savenkova
(N)
M Saraga
(M)
F L Sever
(FL)
M Schreuder
(M)
M Szczepanska
(M)
V Tasic
(V)
B Tonshoff
(B)
K Tullus
(K)
J Vara
(J)
J Vande Walle
(J)
E Volokhina
(E)
J Zieg
(J)
A Waters
(A)
L T Weber
(LT)
N Webbe
(N)
M Wasiak
(M)
K Endén
(K)
A Tsygin
(A)
R Grenda
(R)
A Raes
(A)
J M Van Hoeck Koen
(JM)
B Adams
(B)
M Aksenova
(M)
B Ranchin
(B)
N Hooman
(N)
I Ogarek
(I)
T Seeman
(T)
M Fila
(M)
L Oni
(L)
S Mir
(S)
R Novo
(R)
S Stabouli
(S)
J Vara-Martín
(J)
J A E van Wijk
(JAE)
R Ehren
(R)
Z Bekassy
(Z)
M Herthelius
(M)
F Becherucci
(F)
H Shasha-Lavsky
(H)
F Santos
(F)
M Feldkötter
(M)
M Pańczyk-Tomaszewska
(M)
J Harambat
(J)
D Grima
(D)
I Gökçe
(I)
A Teixeira
(A)
C Licht
(C)
I M Schmidt
(IM)
P Brandström
(P)
N Dinçel
(N)
Informations de copyright
© 2023. The Author(s).
Références
J Rheumatol. 2010 Mar;37(3):558-67
pubmed: 20110520
Can J Kidney Health Dis. 2017 Mar 13;4:2054358117698667
pubmed: 28540057
Ann Oncol. 2006 Sep;17(9):1424-7
pubmed: 16966368
Clin J Am Soc Nephrol. 2016 Apr 7;11(4):710-20
pubmed: 26585985
J Med Internet Res. 2004 Sep 29;6(3):e34
pubmed: 15471760
J Pediatr. 2023 Mar;254:11-16.e1
pubmed: 36223870
Pediatr Nephrol. 2020 Jan;35(1):103-111
pubmed: 31664556
Curr Opin Rheumatol. 2016 May;28(3):251-8
pubmed: 27027812
Pediatr Res. 2018 Oct;84(4):520-526
pubmed: 29983411
J Autoimmun. 2015 Feb;57:60-5
pubmed: 25556904
Pediatr Nephrol. 2020 Mar;35(3):455-462
pubmed: 31705306
World J Clin Cases. 2019 May 6;7(9):1021-1027
pubmed: 31123674
J Rheumatol. 2015 Oct;42(10):1761-6
pubmed: 26276965
Biomed Pharmacother. 2019 Jan;109:2415-2426
pubmed: 30551501
BMC Musculoskelet Disord. 2014 May 25;15:178
pubmed: 24884562
Ann Rheum Dis. 2011 Jun;70(6):909-20
pubmed: 21378402
JAMA Netw Open. 2018 Nov 2;1(7):e184169
pubmed: 30646343
J Autoimmun. 2015 Feb;57:24-9
pubmed: 25586449
Pediatr Nephrol. 2013 Mar;28(3):447-51
pubmed: 23212560
Front Immunol. 2019 Jul 16;10:1653
pubmed: 31379849
Int Rev Immunol. 2017 Nov 2;36(6):352-359
pubmed: 28800262
Front Pediatr. 2019 Jul 30;7:313
pubmed: 31417883
Clin Kidney J. 2017 Aug;10(4):461-469
pubmed: 28852482
Pediatr Nephrol. 2022 May;37(5):1057-1066
pubmed: 34606002
Front Pediatr. 2019 May 10;7:178
pubmed: 31134169
Turk J Med Sci. 2021 Feb 14;51(4):1781-1790
pubmed: 33581711
Rheumatology (Oxford). 2019 May 1;58(5):889-896
pubmed: 30590695
Kidney Int. 2020 Feb;97(2):393-401
pubmed: 31874801
J Am Soc Nephrol. 2015 Sep;26(9):2259-66
pubmed: 25592855
Lancet. 2014 Oct 4;384(9950):1273-81
pubmed: 24965823
Pediatr Rheumatol Online J. 2019 Aug 28;17(1):61
pubmed: 31462263
JAMA Pediatr. 2018 Aug 1;172(8):757-764
pubmed: 29913001
Autoimmun Rev. 2017 Jun;16(6):633-643
pubmed: 28414152
Pediatr Nephrol. 2023 Feb;38(2):451-460
pubmed: 35748947
Clin J Am Soc Nephrol. 2011 Jun;6(6):1308-15
pubmed: 21566104
J Clin Oncol. 1998 Aug;16(8):2825-33
pubmed: 9704735