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Abstract: PO1978

Efficacy and Safety of Long-Term Use of Rituximab in Pediatric Patients with Nephrotic Syndrome

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Choi, Naye, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Min, Jeesu, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Lee, Hyeonju, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Kim, Ji hyun, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Park, Peong Gang, Korea Ministry of Health and Welfare, Sejong, Sejong, Korea (the Republic of)
  • Kang, Hee Gyung, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Ahn, Yo Han, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
Background

Rituximab (RTX) is an effective therapeutic agent widely used in children with nephrotic syndrome (NS). However, long-term effects after the B cell depleting treatment remain unclear. We investigated the efficacy and safety of long-term use of RTX in pediatric NS patients.

Methods

We retrospectively reviewed the medical records of 58 patients with steroid-dependent or steroid-resistant NS who had received more than 3 cycles of RTX. Each cycle consisted of one to four infusions of RTX (375 mg/m2 per dose) until the depletion of B lymphocytes.

Results

The first cycle of RTX was started at the median age of 12.1 (interquartile ranges (IQR) 8.8–14.1) years. Median 5 (IQR 4–8) times of RTX cycles were used during a period of median 4.0 (IQR 2.3-5.9) years. The B lymphocytes recovered to 1% at a median 5.7 (IQR 4.8–6.7) months after the completion of RTX administration. The relapse significantly decreased from median 2.0 (IQR 1.0–3.0) times per year to 0.2 (IQR 0.1–0.5) times per year after long-term RTX treatments (P <0.001). Height growth and hypertension improved significantly compared with prior to the long-term use of RTX. Acute infusion reactions were observed in 21 (36.2%) patients. During long-term RTX treatments, hypogammaglobulinemia developed in 7 (12.1%) patients, and neutropenia was noted in 4 (6.9%) patients. Severe infections which required hospitalization and/or intravenous antibiotic were observed in 6 (10.3%) patients, but no life-threatening infections were identified. No secondary neoplasms or opportunistic infections occurred during the study period.

Conclusion

Long-term therapeutic use of RTX could be effective and relatively safe in pediatric patients with NS. However, impaired immunity should be monitored and carefully followed up during the long-term use of RTX.