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 2 consecutive cases of nongenetic early severe recurrent FSGS refractory to rituximab and anti–interleukin 1 treatment and with a partial response to plasmapheresis. Case 1 was a 22-year-old man who was rescue-treated for recurrence 36 weeks after transplantation with obinutuzumab (1000 mg/1.73 m2, 1 dose) and daratumumab (18 mg/kg each dose, 8 doses), resulting in plasmapheresis discontinuation and a drop of proteinuria from 29 to 2.3 g/d. Proteinuria increased with circulating CD38+ plasma cells and responded to an additional daratumumab dose. Currently, the proteinuria is 1.8 g/d, 14.5 months after discontinuing plasmapheresis and starting obinutuzumab and daratumumab therapy. Case 2 was a 15-year-old girl who was plasmapheresis dependent with 2 g/d 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 (1 dose each), she achieved stable complete remission (0.3 g/d proteinuria) with persistent plasmapheresis discontinuation. These cases suggest the potential of combining obinutuzumab with daratumumab for the treatment of recurrent FSGS.

中文翻译：

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使用 obinutuzumab 和 daratumumab 联合 B 细胞/浆细胞靶向方法挽救严重移植后局灶节段性肾小球硬化复发


肾移植后原发性局灶节段性肾小球硬化症 (FSGS) 的复发与基于血浆置换（联合/不联合利妥昔单抗）的标准治疗的高移植物丢失率相关。我们提出了 2 例连续的非遗传性早期严重复发 FSGS 病例，对利妥昔单抗和抗白细胞介素 1 治疗无效，并且对血浆置换有部分反应。病例1为22岁男性，移植后36周因复发接受奥比妥珠单抗（1000 mg/1.73 m2，1剂）和达雷木单抗（每剂18 mg/kg，8剂）抢救治疗，导致血浆置换停药后蛋白尿从 29 克/天下降至 2.3 克/天。蛋白尿随着循环 CD38+ 浆细胞的增加而增加，并且对额外的达雷妥尤单抗剂量有反应。目前，停止血浆置换并开始 obinutuzumab 和 daratumumab 治疗 14.5 个月后，蛋白尿为 1.8 g/d。病例 2 是一名 15 岁女孩，移植后 82 周，依赖血浆置换，出现 2 g/d 蛋白尿，右颈静脉置有 Tesio 导管作为唯一可能的血管通路。使用 obinutuzumab 和 daratumumab（各 1 剂）治疗后，她实现了稳定的完全缓解（0.3 g/d 蛋白尿），并持续停止血浆置换。这些病例表明将 obinutuzumab 与 daratumumab 联合治疗复发性 FSGS 的潜力。