Background

Rituximab is effective for maintaining remission in patients with complicated nephrotic syndrome, although a history of steroid-resistant nephrotic syndrome (SRNS) is a risk factor for early relapse. We investigated the efficacy of prophylactic rituximab treatment for maintaining remission after B cell recovery.

Methods

Patients with complicated steroid-dependent or frequently relapsing nephrotic syndrome with history of SRNS who received a single dose of rituximab (375 mg/m²) and continued immunosuppressive agents were enrolled in this retrospective study. Patients were divided into two groups: a prophylaxis group, which received additional rituximab treatment at B cell recovery and a non-prophylaxis group. The relapse-free period from the last rituximab infusion (the second treatment in prophylaxis group and the first treatment in non-prophylaxis group) was compared between two groups using the Kaplan-Meier method, and risk factors for early relapse were calculated using multivariate analysis by Cox proportional hazards model.

Results

Sixteen patients in the prophylaxis group and 45 in the non-prophylaxis group were enrolled. Fifty-percent relapse-free survival after the last rituximab treatment was 667 days in the former and 335 days in the latter (p = 0.001). Multivariate analysis showed that additional rituximab treatment was the only significant negative factor for early relapse, with a hazard ratio of 0.40 (p = 0.02). Fifty-percent relapse-free survival after B cell recovery was much longer in the prophylaxis group (954 vs. 205.5 days, p = 0.003).

Conclusions

Additional rituximab treatment at B cell recovery can maintain prolonged remission even after B cell recovery in patients with complicated nephrotic syndrome with history of SRNS.

中文翻译：

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儿童复杂肾病综合征预防性应用利妥昔单抗

背景

尽管类固醇抵抗性肾病综合征 (SRNS) 病史是早期复发的危险因素，但利妥昔单抗可有效维持复杂性肾病综合征患者的缓解。我们研究了预防性利妥昔单抗治疗在 B 细胞恢复后维持缓解的功效。

方法

本回顾性研究招募了接受单剂量利妥昔单抗 (375 mg/m ² ) 和持续免疫抑制剂治疗的具有 SRNS 病史的复杂类固醇依赖型或频繁复发性肾病综合征患者。患者分为两组：预防组（在 B 细胞恢复时接受额外的利妥昔单抗治疗）和非预防组。使用Kaplan-Meier法比较两组自末次输注利妥昔单抗（预防组第二次治疗和非预防组第一次治疗）的无复发期，并使用多变量分析计算早期复发的危险因素通过 Cox 比例风险模型。

结果

预防组有 16 名患者，非预防组有 45 名患者。最后一次利妥昔单抗治疗后 50% 的无复发生存率为前者为 667 天，后者为 335 天（p = 0.001）。多变量分析显示，额外的利妥昔单抗治疗是早期复发的唯一显着负面因素，风险比为 0.40（p = 0.02）。B 细胞恢复后 50% 的无复发存活率在预防组中要长得多（954 天 vs. 205.5 天，p = 0.003）。

结论

在有 SRNS 病史的复杂肾病综合征患者中，即使在 B 细胞恢复后，在 B 细胞恢复时进行额外的利妥昔单抗治疗也可以维持延长的缓解期。