ESPN 54th Annual Meeting

ESPN 2022


 
BASELINE FACTORS ASSOCIATED WITH THE RISK OF RELAPSE FOLLOWING ANTI-CD20 TREATMENT IN CHILDREN WITH FREQUENTLY-RELAPSING/STEROID-DEPENDENT NEPHROTIC SYNDROME
MANUELA COLUCCI 1 ANDREA ANGELETTI 2 ARMANDO DI DONATO 2 MICHELA CIONI 2 GIANLUCA CARIDI 2 FRANCESCA LUGANI 2 PIETRO RAVANI 3 PAOLO CRAVEDI 4 FRANCESCO EMMA 1 GIAN MARCO GHIGGERI 2 MARINA VIVARELLI 1

1- OSPEDALE PEDIATRICO BAMBINO GESù - IRCCS, ROME, ITALY
2- ISTITUTO GIANNINA GASLINI IRCCS, GENOA, ITALY
3- UNIVERSITY OF CALGARY, CALGARY, ALBERTA, CANADA
4- ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI, NEW YORK, NEW YORK
 
Introduction:

B-cell depleting anti-CD20 monoclonal antibodies have prolonged efficacy in children with frequently-relapsing/steroid-dependent nephrotic syndrome (FR/SDNS). However, response to this therapy is variable and treatment-related side effects can occur. We studied the association of several clinical characteristics and laboratory parameters at the baseline with the risk of relapse following anti-CD20 treatment.

Material and methods:

In this retrospective study, we included 102 FR/SDNS pediatric patients treated with anti-CD20 monoclonal antibodies (rituximab or ofatumumab). Time to first relapse during a 24-month follow-up and tapering of concomitant immunosuppression was registered for each patient. We used Cox regression to estimate the association of age, sex, previous immunosuppressive treatment (anti-CD20, prednisone, mycophenolate mofetil, calcineurin inhibitors), duration of concomitant immunosuppression (prednisone, mycophenolate mofetil, calcineurin inhibitors), circulating B-cell subset levels (total CD19+, transitional, mature-naïve and memory B cells) at baseline and time to relapse.

Results:

Univariate analysis showed that age > 9 years at time of anti-CD20 infusion (p=0.012), previous treatment with anti-CD20 (p=0.056) and maintenance immunosuppression with mycophenolate mofetil (p=0.008) were protective against relapse. In contrast, among all the evaluated B-cell subsets at baseline, only high circulating levels of memory B cells (p<0.001) were significantly associated with relapse. By multivariate analysis, age > 9 years (p=0.017), maintenance of mycophenolate mofetil treatment (p=0.045) and levels of memory B cells at baseline (p=0.003) retained their significant association with time to relapse, whilst previous treatment with anti-CD20 did not (p=0.906).

Conclusions:

Younger age and high circulating levels of memory B cells at time of anti-CD20 infusion are associated with a higher risk of relapse following anti-CD20 administration. The maintenance of mycophenolate mofetil treatment, more than other immunosuppressors, may prolong remission following anti-CD20 infusion.