Abstract: SA-PO0200
Rituximab (RTX): Not Only Effective in Anti-Phospholipase A2 Receptor (PLA2R)-Associated Membranous Nephropathy (MN)
Session Information
- Onconephrology: MGRS, HSCT, Electrolytes, RCC, and More
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Monrroy, Mauricio, Albany Medical College, Albany, New York, United States
- Sidhu, Harmaan, The Albany Academies, Albany, New York, United States
- Ali, Omar, Albany Medical College, Albany, New York, United States
- Lightle, Andrea R., Albany Medical College, Albany, New York, United States
- Mehta, Swati, Albany Medical College, Albany, New York, United States
Introduction
MN is a rare complication post allogenic hematopoietic stem cell transplantation (HSCT). Chronic graft-vs-host disease (GVHD) has been reported to be a risk factor. We describe a case of complete remission after extended therapy with RTX.
Case Description
66 years old man with history of T-cell lymphoblastic lymphoma status post allogenic HSCT 2 years before presentation, complicated by chronic GVHD with skin and liver involvement, chronically on ruxolitinib and briefly on belumosudil, presented with acute onset lower extremity edema, proteinuria 7600 mg in 24 hours, serum albumin 2.1 g/dL, serum creatinine 1.3 mg/dL (base 1.1). Additionally total cholesterol 662 mg/dL and LDL 456 mg/dL, negative serum antiPLA2R antibody. Underwent kidney biopsy that showed MN with global subepithelial electron dense deposits, 100% podocyte foot processes effacement, negative PLA2R and THSD7A. MN deemed to be related to HSCT. Received RTX 1 gram x2 doses two weeks apart with total depletion of CD19 cells. Irbesartan started, apixaban for DVT prophylaxis, atorvastatin and evolocumab for dyslipidemia. Six months later his proteinuria remained at 7.9 grams, CD19 cells were reconstituted at 33 cells/cmm, and creatinine increased to 1.8 mg/dL. RTX 1 gram x2 doses was repeated, dapagliflozin was added. Twelve-months after diagnosis proteinuria started to decline to 3.5 grams, albumin up to 3.1 mg/dL. A fifth Rituximab 1gr dose was given. Twenty-two months after his diagnosis, proteinuria normalized with UPCR below 200 mg/g in several measures, creatinine 1.2 mg/dL, albumin 4.2 mg/dL, cholesterol 154 mg/dL. Clinically doing excellent in complete remission, remains on irbesartan, dapagliflozin, atorvastatin, and evolocumab.
Discussion
Treatment of MN post allogenic HSCT is based on case report and case series, and different agents have been used including calcineurin inhibitors, mycophenolate mofetil, cyclophosphamide, and more recently rituximab. The clinical course in our patient was protracted requiring repetitive dosing of RTX before a clinical response was noted. The lack of serological markers (i.e. antiPLA2R antibody) made the decision to continue with RTX and not changing to a different agent difficult, but it proved to be effective. In HSCT associated MN, a prolonged RTX course is probably necessary and beneficial to achieve adequate response.