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Hypogammaglobulinemia during the RTX treatment in steroid dependant nephrotic syndrome
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Edité par CCSD -
International audience. INTRODUCTION: Rituximab (RTX) is efficient in steroid dependent nephrotic syndrome (SDNS) in pediatric and adult patients. The aim of this study is to describe hypogammaglobulinemia as a side effect of RTX treatment in these patients.METHODS: All pediatric patients of four French pediatric nephrology centers who received RTX for SDNS between 2010 and 2015 have been included. Clinical and biological data have been analyzed retrospectively before, during and after RTX treatment. Hypogammaglobulinemia was defined as an IgG level < -2 standard deviation for patient age.RESULTS: 107 pediatric patients have been included, 65.9% were boys, median age at nephrotic syndrome diagnosis was 3.1 interquartile range (IQR) [2.24-5.45] years and age at RTX introduction was 11.7 [8.6-14.2] years. Median IgG level before the RTX initiation was 6.42 g/l [5.25-7.54]. 19.6% of patients had hypogammaglobulinemia before the initiation of RTX. 23.3% of patients had at least one hypogammaglobulinemia during B cell depletion or after B cell recovery while IgG level at initiation was normal. These patients were younger at RTX initiation with a median age 8.23 years IQR [6.3-12.4]. Among the 46 patients with hypogammaglobulinemia during follow up, 28% had a concomitant infection. Patients with a concomitant infection during RTX were also younger (6.5 years [5.2-14.6]) than the others at RTX initiation. 73% of them were younger than eight years at the introduction of RTX.CONCLUSIONS: Hypogammaglobulinemia is a frequent complication of RTX treatment in younger children treated for SDNS. The use of RTX in children younger than 8 years has to be carefully evaluated and their clinical and biological follow up should be adapted to the increased risk profil for hypogammaglobulinemia.
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