ABSTRACT
The recurrence of primary focal segmental glomerulosclerosis (FSGS) after kidney transplantation is associated with a high graft loss rate with standard treatments based on plasmapheresis with/without rituximab. We present two consecutive cases of non-genetic early severe recurrent FSGS refractory to rituximab and anti-interleukin-1 treatment and with a partial response to plasmapheresis. Case 1: a 22-year-old man was rescue-treated for recurrence 36 weeks after transplantation with obinutuzumab (1000 mg/1.73 m2, one dose) and daratumumab (18 mg/kg each dose, eight doses), resulting in plasmapheresis discontinuation and a drop of proteinuria from 29 to 2.3 g/day. Proteinuria increased with circulating CD38+ plasma cells, and responded to an additional daratumumab dose. Currently, the proteinuria is 1.8 g/day, 14.5 months after discontinuing plasmapheresis and starting obinutuzumab and daratumumab therapy. CASE 2: A 15-year-old girl was plasmapheresis-dependent with 2 g/day proteinuria 82 weeks after transplantation, with a Tesio® catheter in the right jugular vein as the only possible vascular access. After treatment with obinutuzumab and daratumumab (one dose each), she achieved stable complete remission (0.3 g/day proteinuria) with persistent plasmapheresis discontinuation. These cases suggest the potential of combining obinutuzumab with daratumumab for the treatment of recurrent FSGS.
