title: Rituximab-cyclophosphamide-dexamethasone is highly effective in patients with monoclonal Ig deposit-related glomerulopathy and indolent non-Hodgkin lymphomas.
abstract: 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.
authors.affiliation: Service d'Hématologie, CHU Lyon Sud, Pierre-Bénite, Lyon, France.
authors.forename: Marielle
authors.initials: M
authors.lastname: Perry
authors.forename: Antoine
authors.initials: A
authors.lastname: Delarche
authors.forename: David
authors.initials: D
authors.lastname: Ribes
authors.forename: François
authors.initials: F
authors.lastname: Vergez
authors.forename: Céline
authors.initials: C
authors.lastname: Guilbeau-Frugier
authors.forename: Camille
authors.initials: C
authors.lastname: Laurent
authors.forename: Antoine
authors.initials: A
authors.lastname: Huart
authors.forename: Suzanne
authors.initials: S
authors.lastname: Tavitian
authors.forename: Hélène
authors.initials: H
authors.lastname: El Hachem
authors.forename: Lucie
authors.initials: L
authors.lastname: Oberic
authors.forename: Dominique
authors.initials: D
authors.lastname: Chauveau
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Michallet
authors.forename: Loïc
authors.initials: L
authors.lastname: Ysebaert
authors.forename: Stanislas
authors.initials: S
authors.lastname: Faguer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D058225:Plaque, Amyloid / Q000188:drug therapy / Q000503:physiopathology; D011014:Pneumonia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D003907:Dexamethasone; D003520:Cyclophosphamide