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Abstract: PO1884

Targeted B-Cell Depletion with Rituximab in Adult Relapsing Minimal Change Disease

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Dattani, Rakesh, Imperial College NHS Healthcare Trust, London, London, United Kingdom
  • Cairns, Tom, Imperial College NHS Healthcare Trust, London, London, United Kingdom
  • Condon, Marie B., Imperial College NHS Healthcare Trust, London, London, United Kingdom
  • Levy, Jeremy B., Imperial College NHS Healthcare Trust, London, London, United Kingdom
  • Lightstone, Liz, Imperial College NHS Healthcare Trust, London, London, United Kingdom
  • McAdoo, Stephen Paul, Imperial College NHS Healthcare Trust, London, London, United Kingdom
  • Tam, Frederick W.K., Imperial College NHS Healthcare Trust, London, London, United Kingdom
  • Griffith, Megan, Imperial College NHS Healthcare Trust, London, London, United Kingdom
Background

Case series suggest use of rituximab is effective in treating adults with relapsing Minimal Change Disease (MCD). We previously reported rituximab to increase time in remission, however, the majority of patients did have further relapses. We thus studied the efficacy of retreatment with rituximab on B cell repletion for 2 years to prevent relapse.

Methods

Adult patients with recurrent MCD relapses were identified and treated with rituximab and monitored for lymphocyte depletion (total B-lymphocyte <10) with pre-emptive re-dosing after reconstitution was observed.

Results

16 patients (8 female, 8 male) started B cell targeted maintenance rituximab for up to 2 years. At start of the maintenance period, 14/16 were on immunosuppression, tacrolimus (7) steroids (3), or both (4), stopped at a mean of 6.4 months (range 2-16 months). 15/16 patients re-dosed after reconstitution was observed. 1/16 received 6 monthly rituximab, without waiting for lymphocyte reconstitution, due to a history of rapidly relapsing disease.

16/16 achieved lymphocyte depletion post rituximab. 3/16 relapsed during the 2 year treatment period, 1/3 was B cell deplete at relapse, 2/3 were B cell replete at relapse having been deplete on their previous blood test. As of May 2020, 10/16, have completed 2 years treatment, with a mean follow up post treatment of 6.6 months (range 1 to 13. ). Of these 3/10 have subsequently relapsed at mean time of 3.3 months (range 1-5), 2/3 were B cell replete at relapse.

Rituximab was generally well tolerated, with no significant hypogammaglobinaemia or hospital admissions observed.

Conclusion

Targeting B cell depletion with rituximab is effective in maintaining remission of MCD. However, relapse can occur rapidly post repletion of lymphocytes, so frequent monitoring of lymphocyte subsets is required to ensure early retreatment upon reconstitution. An alternative strategy maybe pre-emptive rituximab dosing at fixed intervals. Even after 2 years of maintenance therapy, B cell repletion is still associated with relapse. Further work is needed to compare maintenance strategies and to determine the optimal length of time of maintenance rituximab.