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Relapse of nephrotic syndrome during post-rituximab peripheral blood B-lymphocyte depletion

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Abstract

Background

Rituximab is effective against complicated childhood steroid-dependent nephrotic syndrome (SDNS). Peripheral blood B-lymphocyte (B-cell) depletion is strongly correlated with persistent remission, relapse rarely occurring during B-cell depletion; however, we have encountered several such patients.

Methods

We retrospectively analyzed the characteristics and clinical course of 82 patients with SDNS treated with rituximab from January 2007 to December 2012 in our institution.

Results

Six of 82 patients (7.3%) had relapses during B-cell depletion after receiving rituximab (relapsed group). The remaining 76 patients did not have relapses during B-cell depletion (non-relapsed group). The median time to initial relapse during B-cell depletion was 85 days after receiving rituximab, which is significantly shorter than in the non-relapsed group (410 days, p = 0.0003). The median annual numbers of relapses after receiving rituximab were 2.5 and 0.9 in the relapsed and non-relapsed groups, respectively (p < 0.0001). Five patients in the relapsed group also had a total of 10 relapses after B-cell recovery; their median time from B-cell recovery to initial relapse was significantly shorter than in the non-relapsed group (31 vs. 161 days, p = 0.014). Number of relapses before rituximab, history of steroid resistance, onset age, previous treatment, time to ceasing steroids after rituximab, and duration of B-cell depletion did not differ between the two groups.

Conclusion

Relapse during B-cell depletion after receiving rituximab suggests that various pathophysiological mechanisms play a part in childhood nephrotic syndrome.

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Acknowledgements

Edanz Group provided language editorial support in the preparation of the manuscript.

Author information

Authors and Affiliations

  1. Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, 157-8535, Japan

    Mai Sato, Koichi Kamei, Masao Ogura & Kenji Ishikura

  2. Department of Pediatrics, Yokohama City University Hospital, Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan

    Shuichi Ito

Authors
  1. Mai Sato
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  2. Koichi Kamei
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  3. Masao Ogura
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  4. Kenji Ishikura
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  5. Shuichi Ito
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Contributions

MS prepared the manuscript; MO and KK collected the clinical data; KI revised the article; SI oversaw the work as the corresponding author and revised the article.

Corresponding author

Correspondence to Shuichi Ito.

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Funding statement

There is no funding to report for this submission.

Conflict of interest

MS and MO have no financial relationships relevant to this article to disclose. KK has received lecture fees from Chugai Pharma. KI has received lecture fees and travel expenses from Novartis Pharma and Asahi Kasei Pharma. SI has received lecture fees and travel expenses from Novartis Pharma, Asahi Kasei Pharma, Astellas Pharma and Chugai Pharma.

Research involving human participants and/or animals

This study was conducted in accordance with the principles of the Declaration of Helsinki and the ethical guidelines issued by the Ministry of Health, Labour and Welfare, Japan. The study was approved by a central ethics board at National Center for Child Health and Development (Approval number: 1316).

Informed consent

Because reported data were extracted from patients’ medical records, informed consent for participation in the study was not required.

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Sato, M., Kamei, K., Ogura, M. et al. Relapse of nephrotic syndrome during post-rituximab peripheral blood B-lymphocyte depletion. Clin Exp Nephrol 22, 110–116 (2018). https://doi.org/10.1007/s10157-017-1415-8

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  • DOI: https://doi.org/10.1007/s10157-017-1415-8

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