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04-01-2025 | Rituximab | Original Article

Risk factors and retreatment for relapse in childhood primary nephrotic syndrome treated with rituximab

Authors: Yuanzhao Zhi, Lu Cao, Rui Gu, Qin Wang, Peipei Shi, Lin Zhu, Wai W. Cheung, Ping Zhou, Jianjiang Zhang

Abstract

Background

The effectiveness of rituximab (RTX) for steroid-dependent/frequently relapsing nephrotic syndrome (SDNS/FRNS) in children is well documented. However, there are insufficient data on relapse risk factors. Additionally, the retreat regimen for relapsed children requires further investigation.

Methods

We administered single dose RTX (375 mg/m², maximum 500 mg) to children with SDNS/FRNS between May 2020 and December 2022. An additional single dose of RTX was administered when B-cell depletion (CD19 + B cells < 1%) was incomplete or B-cell recovery (CD19 + B cells ≥ 1%) occurred. Primary and secondary outcomes were the first and second relapse, respectively.

Results

Eighty-nine patients were included and the observation period was 12.2–43.2 months. Thirty-three patients (37.1%) relapsed after RTX treatment. Multivariate analysis showed that previous steroid-resistant nephrotic syndrome (SRNS) history and low NK-cell percentage at initial RTX treatment were independent risk factors for first relapse. In the relapse group, 26 patients (78.8%) continued RTX treatment upon B-cell recovery. During mean follow-up period of (15.4 ± 8.1) months, 15 patients (45.5%) experienced a second relapse. Compared with non-continued RTX treatment group, the continued RTX treatment group had a lower relapse rate (34.6% (9/26) versus 85.7% (6/7); P = 0.047) and fewer relapses (0.0 (0.0, 0.6) versus 1.8 (0.9, 2.7) times/year; P = 0.004). Multivariate analysis showed that continued RTX treatment was the protective factor for second relapse.

Conclusion

Previous SRNS history and low NK-cell percentage at initial RTX treatment may be associated with higher risk of relapse. Despite the possibility of relapse during RTX treatment, continued RTX treatment is effective in reducing relapse.

Graphical abstract

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Title: Risk factors and retreatment for relapse in childhood primary nephrotic syndrome treated with rituximab
Authors: Yuanzhao Zhi
Lu Cao
Rui Gu
Qin Wang
Peipei Shi
Lin Zhu
Wai W. Cheung
Ping Zhou
Jianjiang Zhang
Publication date: 04-01-2025
Publisher: Springer Berlin Heidelberg
Keywords: Rituximab
Rituximab
Nephrotic Syndrome
Published in: Pediatric Nephrology
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-024-06622-z

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