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CASE REPORT article

Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders: Autoinflammatory Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1525892

Case Report: Single infusion of combined anti-CD20 and anti-CD38 monoclonal antibodies in pediatric refractory Lupus Nephritis

Provisionally accepted
Andrea Angeletti Andrea Angeletti 1*Decimo Silvio Chiarenza Decimo Silvio Chiarenza 1Raul Mancini Raul Mancini 1Carolina Bigatti Carolina Bigatti 1Gianluca Caridi Gianluca Caridi 1Alessandro Consolaro Alessandro Consolaro 2Valentina Natoli Valentina Natoli 2Gabriele Mortari Gabriele Mortari 2Xhuliana Kajana Xhuliana Kajana 1Francesca Lugani Francesca Lugani 1Marco Gattorno Marco Gattorno 2Gian Marco Ghiggeri Gian Marco Ghiggeri 1Edoardo La Porta Edoardo La Porta 1Gabriele Gaggero Gabriele Gaggero 3Enrico Eugenio Verrina Enrico Eugenio Verrina 1
  • 1 Department of Nephrology and Kidney Transplantation, Giannina Gaslini Institute (IRCCS), Genoa, Italy
  • 2 Division of Rheumatology, Giannina Gaslini Institute (IRCCS), Genoa, Italy
  • 3 Department of Pathological Anatomy, Giannina Gaslini Institute (IRCCS), Genoa, Italy

The final, formatted version of the article will be published soon.

    Lupus nephriBs (LN), present in 30-50% of systemic lupus erythematosus (SLE) paBents, o\en necessitates standard immunosuppressive therapy (glucocorBcoids, MMF, CYC) as suggested by EULAR/ERA-EDTA and KDIGO guidelines. However, a subset of subjects remains refractory. Recent findings suggested the efficacy of targeBng CD38-long-lived plasma cells in LN and SLE refractory to standard treatment. However, previous experiences were limited to adult paBents and described different therapeuBcal schemes based on daratumumab, with the addiBon or not of belimumab.Moreover, the minimal effecBve 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 combinaBon of single infusion of rituximab (targeBng CD20 on B cells) and daratumumab (targeBng CD38 on long-lived plasma cells), unlike prior regimens requiring prolonged daratumuab infusions. Our approach was safe and effecBve and may potenBally reduce adverse effects and costs, providing a novel therapeuBc opBon for juvenile refractory LN.

    Keywords: Systemic Lupus Erythematous, Lupus nephriBs, rituximab; daratumumab, monoclonal anBbodies, pediatric

    Received: 10 Nov 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Angeletti, Chiarenza, Mancini, Bigatti, Caridi, Consolaro, Natoli, Mortari, Kajana, Lugani, Gattorno, Ghiggeri, La Porta, Gaggero and Verrina. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Andrea Angeletti, Department of Nephrology and Kidney Transplantation, Giannina Gaslini Institute (IRCCS), Genoa, Italy

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