Premium
Rituximab–cyclophosphamide‐dexamethasone is highly effective in patients with monoclonal I g deposit‐related glomerulopathy and indolent non‐ H odgkin lymphomas
Author(s) -
Perry Marielle,
Delarche Antoine,
Ribes David,
Vergez François,
GuilbeauFrugier Céline,
Laurent Camille,
Huart Antoine,
Tavitian Suzanne,
El Hachem Hélène,
Oberic Lucie,
Chauveau Dominique,
Michallet AnneSophie,
Ysebaert Loïc,
Faguer Stanislas
Publication year - 2014
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23798
Subject(s) - rituximab , medicine , cyclophosphamide , dexamethasone , glomerulopathy , gastroenterology , monoclonal , proteinuria , membranoproliferative glomerulonephritis , immunology , lymphoma , chemotherapy , antibody , kidney , monoclonal antibody
Indolent non‐hodgkin lymphomas (iNHL) are a rare cause of monoclonal immunoglobulin deposits‐related glomerulopathy (mIgGN). In patients with iNHL‐related mIgGN, whether treatment should include either single or a combination of drug(s) to target the malignant clone and renal inflammation remains elusive. In this retrospective study, we report a cohort of 14 patients with iNHL‐related mIgGN (cryoglobulinemic glomerulonephritis [ n = 5], membranous nephropathy [ n = 3], membranoproliferative glomerulonephritis [ n = 3], AL or AL/AH amyloidosis [ n = 2], and Light Chain Deposits Disease [ n = 1]) and who received a treatment combining rituximab, cyclophosphamide, and dexamethasone (RCD). After a mean follow‐up of 18 ± 4 months, nine patients (63%) had complete haematological response. Renal response was observed in 12 of the 14 patients (86%; complete response: n = 9; partial: n = 3). Estimated glomerular filtration rate increased from 47 ± 7 to 63 ± 8 mL/min/1.73 m 2 , and proteinuria decreased from 6.5 ± 0.7 to 1.4 ± 0.8 g/24 hr at one year. Following hematological relapse, renal relapse occurred in two patients suggesting sustained clonal eradication offers the best renal protection. Tolerance of RCD was good and the most frequent adverse event was pneumonia (3/14, 21%). RCD is a promising regimen for patients with iNHL and mIgGN, irrespective of glomerular pathologic pattern. Whether steroids can be avoided or minimized remains to be addressed. Am. J. Hematol. 89:969–973, 2014. © 2014 Wiley Periodicals, Inc.