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Kidney Week

Abstract: TH-PO622

Obinutuzumab in Children with Kidney Diseases: A Single-Center Experience

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

  • Vyas, Shefali, RWJBarnabas Health, West Orange, New Jersey, United States
  • Nath, Ursula, University of Delaware, Newark, Delaware, United States
  • Steinman, Benjamin, RWJBarnabas Health, West Orange, New Jersey, United States
  • Roberti, Isabel, RWJBarnabas Health, West Orange, New Jersey, United States
Background

Chart review of children with refractory kidney diseases treated with Obinutuzumab. Obinutuzumab an antiCD20 monoclonal antibody developed to overcome rituximab resistance in B-cell malignancies, has demonstrated superior outcomes. Obinutuzumab is proven to be effective in the treatment of active lupus nephritis and membranous nephropathy. There are only 2 peds studies reporting its use in SDNS and MN.

Methods

Chart review was done of children who received Obinutuzumab between 2020 and 2024. All received Obinutuzumab (1000 mg/1.73 m2/dose) and one received Ofatumumab (300 mg/1.73 m2/dose).
Indications: adverse reaction or disease relapse after Rituximab; refractory nephropathies to standard therapy ( abnormal eGFR or severe proteinuria).
Demographic data, etiology of kidney disease, kidney biopsy results, therapies used, eGFR, Urine pr/cr, follow-up time& side effects were collected. Improvement in the degree of proteinuria and/or eGFR changes were reviewed

Results

Total of 46 infusions in 29 patients. Male 52%, Hisp 52%, AA= 27%, C= 7% and other =14%. Median age at presentation = 5 yrs.
Etiology: NS= 22 (76%) [SDNS=13 (59%), SRNS= 41%]; 2 pts post Txp NS (1 FSGS recurrence; 1 de novo MCNS); chronic GN = 5 (17%) (C3GN, SLE, IgAN, C1Q); AIN with AKI=2 (7%). Biopsy =25 (96%).
Initial therapy: All received steroids; Ritx= 20 (69%), CNI (tacro/CSA) = 19 (66%), MMF= 17 (59%), Cytx =7 (30%).
Median age at time of med =13 yrs, Median time to respond = 25 days. Time of obinutuzumab from diagnosis 2m-14 years (median 4 yrs).
6 patients received > 2 doses
Proteinuria: 34 infusions at the time of relapse. Pre-tx no proteinuria =1, mild proteinuria (<2.5 g/g Cr) = 6 ; nephrotic proteinuria (>2.5g/g Cr) = 27.
AKI/CKD =6 (20%)
ACEi/ARBs: 48%(14/29) HTN= 24% (7/29)
Post-tx = 6 patients had mild proteinuria and 1 nephrotic range. ( pvalue <0.001) Complete remission of proteinuria was achieved in 75%.
At last follow up: CKD=5; in all eGFR improved with average 33% post tx. 1 death
Follow up time (3 to 44 mos; median= 10). Post tx: all patients off steroids and 24% (7/29) off all immunosuppressive therapy

Conclusion

Obinutuzumab was well tolerated in children with various refractory nephropathies. We noted significant reduction in proteinuria and 33% improvement in eGFR. All patients were able to be weaned off the steroids, 75% had complete remission and 24% were off all medications.