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Immunoglobulin serum levels in rituximab-treated patients with steroid-dependent nephrotic syndrome

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Abstract

Background

Rituximab (RTX) is efficient in steroid-dependent nephrotic syndrome (SDNS) in pediatric and adult patients. The aim of this study is to describe hypogammaglobulinemia as a side effect of RTX treatment.

Methods

All pediatric patients (< 18 years old) of four French pediatric nephrology centers who received RTX for SDNS between 2010 and 2015 have been included. Clinical and biological data have been analyzed retrospectively before, during, and after RTX treatment. Hypogammaglobulinemia was defined as an IgG level < − 2 standard deviations for patient age.

Results

A total of 107 pediatric patients have been included, 65.9% were boys, median age at nephrotic syndrome diagnosis was 3.1 interquartile range [IQ 2.24–5.45] years and age at RTX introduction was 11.7 [IQ 8.6–14.2] years. Twenty-one patients had hypogammaglobulinemia before the initiation of RTX. Of the patients, 25/86 had at least one hypogammaglobulinemia during B cell depletion or after B cell recovery while IgG levels at initiation were normal with a persisting hypogammaglobulinemia for 13 patients 1 year after B cell recovery. Patients who developed hypogammaglobulinemia were younger at RTX initiation with a median age of 8.2 years [IQ 6.3–12.4]. Among all the 46 patients with hypogammaglobulinemia during follow-up, 13 had a concomitant infection.

Conclusions

Hypogammaglobulinemia is a frequent complication of RTX treatment in younger children treated for SDNS. The use of RTX in children has to be carefully evaluated and their clinical and biological follow-up should be adapted to the age-dependent risk profile for hypogammaglobulinemia.

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Authors and Affiliations

  1. Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012, Paris, France

    Cyrielle Parmentier, Jean-Daniel Delbet & Tim Ulinski

  2. Sorbonne University, Paris, France

    Cyrielle Parmentier & Tim Ulinski

  3. Inflammation–Immunopathology–Biotherapy, DHU i2b, Paris, France

    Cyrielle Parmentier, Jean-Daniel Delbet & Tim Ulinski

  4. Pediatric Nephrology and Rheumatology, CHU, Toulouse, France

    Stéphane Decramer

  5. Pediatric Nephrology Unit, Necker Hospital, APHP, Paris, France

    Olivia Boyer

  6. Pediatric Nephrology Unit, Robert-Debré Hospital, APHP, Paris, France

    Julien Hogan

Authors
  1. Cyrielle Parmentier
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  2. Jean-Daniel Delbet
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  3. Stéphane Decramer
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  4. Olivia Boyer
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  5. Julien Hogan
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  6. Tim Ulinski
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Correspondence to Tim Ulinski.

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Parmentier, C., Delbet, JD., Decramer, S. et al. Immunoglobulin serum levels in rituximab-treated patients with steroid-dependent nephrotic syndrome. Pediatr Nephrol 35, 455–462 (2020). https://doi.org/10.1007/s00467-019-04398-1

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  • DOI: https://doi.org/10.1007/s00467-019-04398-1

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