Case report: Single infusion of combined anti-CD20 and anti-CD38 monoclonal antibodies in pediatric refractory lupus nephritis
Lupus nephritis (LN), present in 30%–50% of systemic lupus erythematosus (SLE) patients, often necessitates standard immunosuppressive therapy (glucocorticoids, MMF, CYC) as suggested by the European League Against Rheumatism/European Renal Association–European Dialysis and Transplant Association (E...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1525892/full |
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| author | Decimo Silvio Chiarenza Raul Mancini Carolina Bigatti Carolina Bigatti Gianluca Caridi Alessandro Consolaro Alessandro Consolaro Valentina Natoli Valentina Natoli Gabriele Mortari Xhuliana Kajana Francesca Lugani Marco Gattorno Marco Gattorno Gian Marco Ghiggeri Edoardo La Porta Gabriele Gaggero Enrico E. Verrina Andrea Angeletti |
| author_facet | Decimo Silvio Chiarenza Raul Mancini Carolina Bigatti Carolina Bigatti Gianluca Caridi Alessandro Consolaro Alessandro Consolaro Valentina Natoli Valentina Natoli Gabriele Mortari Xhuliana Kajana Francesca Lugani Marco Gattorno Marco Gattorno Gian Marco Ghiggeri Edoardo La Porta Gabriele Gaggero Enrico E. Verrina Andrea Angeletti |
| author_sort | Decimo Silvio Chiarenza |
| collection | DOAJ |
| description | Lupus nephritis (LN), present in 30%–50% of systemic lupus erythematosus (SLE) patients, often necessitates standard immunosuppressive therapy (glucocorticoids, MMF, CYC) as suggested by the European League Against Rheumatism/European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) and Kidney Disease Improving Global Outcomes (KDIGO) guidelines. However, a subset of subjects remains refractory. Recent findings suggested the efficacy of targeting CD38-long-lived plasma cells in LN and SLE refractory to standard treatment. However, previous experiences were limited to adult patients and described different therapeutical schemes based on daratumumab, with the addition or absence of belimumab. Moreover, the minimal effective dose of daratumumab has yet to be fully defined. In this report, we describe two cases of juvenile-onset refractory LN/SLE successfully managed with a combination of a single infusion of rituximab (targeting CD20 on B cells) and daratumumab (targeting CD38 on long-lived plasma cells), unlike prior regimens requiring prolonged daratumumab infusions. Our approach was safe and effective and may potentially reduce adverse effects and costs, providing a novel therapeutic option for juvenile refractory LN. |
| format | Article |
| id | doaj-art-6180d58ffb83478eae7e02fe7bd5543c |
| institution | Kabale University |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj-art-6180d58ffb83478eae7e02fe7bd5543c2025-01-28T06:41:17ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-01-011610.3389/fimmu.2025.15258921525892Case report: Single infusion of combined anti-CD20 and anti-CD38 monoclonal antibodies in pediatric refractory lupus nephritisDecimo Silvio Chiarenza0Raul Mancini1Carolina Bigatti2Carolina Bigatti3Gianluca Caridi4Alessandro Consolaro5Alessandro Consolaro6Valentina Natoli7Valentina Natoli8Gabriele Mortari9Xhuliana Kajana10Francesca Lugani11Marco Gattorno12Marco Gattorno13Gian Marco Ghiggeri14Edoardo La Porta15Gabriele Gaggero16Enrico E. Verrina17Andrea Angeletti18Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyTranslational Transplant Research Center and Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesNephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyRheumatology and Autoinflammatory Diseases, IRCCS Istituto Giannina Gaslini, Genova, ItalyDipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genova, ItalyRheumatology and Autoinflammatory Diseases, IRCCS Istituto Giannina Gaslini, Genova, ItalyDipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genova, ItalyNephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyRheumatology and Autoinflammatory Diseases, IRCCS Istituto Giannina Gaslini, Genova, ItalyDipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genova, ItalyNephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyPathology Unit, IRCCS Istituto Giannina Gaslini, Genova, ItalyNephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyLupus nephritis (LN), present in 30%–50% of systemic lupus erythematosus (SLE) patients, often necessitates standard immunosuppressive therapy (glucocorticoids, MMF, CYC) as suggested by the European League Against Rheumatism/European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) and Kidney Disease Improving Global Outcomes (KDIGO) guidelines. However, a subset of subjects remains refractory. Recent findings suggested the efficacy of targeting CD38-long-lived plasma cells in LN and SLE refractory to standard treatment. However, previous experiences were limited to adult patients and described different therapeutical schemes based on daratumumab, with the addition or absence of belimumab. Moreover, the minimal effective dose of daratumumab has yet to be fully defined. In this report, we describe two cases of juvenile-onset refractory LN/SLE successfully managed with a combination of a single infusion of rituximab (targeting CD20 on B cells) and daratumumab (targeting CD38 on long-lived plasma cells), unlike prior regimens requiring prolonged daratumumab infusions. Our approach was safe and effective and may potentially reduce adverse effects and costs, providing a novel therapeutic option for juvenile refractory LN.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1525892/fullsystemic lupus erythematouslupus nephritisrituximabdaratumumabmonoclonal antibodiespediatric |
| spellingShingle | Decimo Silvio Chiarenza Raul Mancini Carolina Bigatti Carolina Bigatti Gianluca Caridi Alessandro Consolaro Alessandro Consolaro Valentina Natoli Valentina Natoli Gabriele Mortari Xhuliana Kajana Francesca Lugani Marco Gattorno Marco Gattorno Gian Marco Ghiggeri Edoardo La Porta Gabriele Gaggero Enrico E. Verrina Andrea Angeletti Case report: Single infusion of combined anti-CD20 and anti-CD38 monoclonal antibodies in pediatric refractory lupus nephritis Frontiers in Immunology systemic lupus erythematous lupus nephritis rituximab daratumumab monoclonal antibodies pediatric |
| title | Case report: Single infusion of combined anti-CD20 and anti-CD38 monoclonal antibodies in pediatric refractory lupus nephritis |
| title_full | Case report: Single infusion of combined anti-CD20 and anti-CD38 monoclonal antibodies in pediatric refractory lupus nephritis |
| title_fullStr | Case report: Single infusion of combined anti-CD20 and anti-CD38 monoclonal antibodies in pediatric refractory lupus nephritis |
| title_full_unstemmed | Case report: Single infusion of combined anti-CD20 and anti-CD38 monoclonal antibodies in pediatric refractory lupus nephritis |
| title_short | Case report: Single infusion of combined anti-CD20 and anti-CD38 monoclonal antibodies in pediatric refractory lupus nephritis |
| title_sort | case report single infusion of combined anti cd20 and anti cd38 monoclonal antibodies in pediatric refractory lupus nephritis |
| topic | systemic lupus erythematous lupus nephritis rituximab daratumumab monoclonal antibodies pediatric |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1525892/full |
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