Grisaru, S

Hamiwka, LA

Midgley, JP

Miettunen, PM

Wade, AW

English

PubMed

PM Miettunen

LA Hamiwka

AW Wade

JP Midgley

S Grisaru

Crossref

Effective use of rituximab in combination with low dose cyclophosphamide in childhood onset systemic lupus erythematosus (SLE) with relapsing class IV nephritis

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BioMed Central
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Pediatric Rheumatology
Open AccessPoster presentation
Effective use of rituximab in combination with low dose 
cyclophosphamide in childhood onset systemic lupus 
erythematosus (SLE) with relapsing class IV nephritis
PM Miettunen*, LA Hamiwka, AW Wade, JP Midgley and S Grisaru
Address: University of Calgary, Calgary, Alberta, Canada
* Corresponding author    
Objectives
We evaluated effectiveness of rituximab, an anti-CD20
monoclonal antibody, in combination with low dose
cyclophosphamide and intravenous (IV) methylpred-
nisolone in three pediatric SLE patients with relapsing
class IV nephritis.
Methods
Patients 1 and 2
Identical twin females with SLE, complicated by biopsy
proven class IV nephritis at age 6-years and treated with
NIH cyclophosphamide protocol (NIHCP), had biopsy
documented Class IV renal flare at age 10-years; unre-
sponsive to mycophenolate mofetil (MMF) and corticos-
teroids.
Patient 3
A 12-year old female with SLE, complicated by biopsy
documented Class IV nephritis and treated with NIHCP,
had 2 further renal flares, which responded to a cumula-
tive dose of 36 grams of cyclophosphamide. At age 16, she
had another biopsy documented class IV renal flare,
despite maintenance with MMF.
All patients received pulse therapy with: IV cyclophospha-
mide 0.5 g/m2 with IV methylprednisolone (IVMP) 250
mg on days 1 and 23; IV rituximab 375 mg/m2 on days 2,
9, 16 and 23.
Results
All 3 patients had a dramatic improvement in urine pro-
tein-creatinine ratios, and normalization of blood pres-
sure. Despite low-dose daily corticosteroids, all patients
had an increase in generalized SLE activity by 4 weeks fol-
lowing rituximab therapy, which responded to re-intro-
duction of MMF. No side effects apart from expected
decrease in B-cell counts were noted.
Conclusion
Rituximab in combination with low dose cyclophospha-
mide and IVMP was effective in controlling recurrent class
IV nephritis in 3 pediatric SLE patients.
Re-introduction of mycophenolate mofetil was required
within 4 weeks following rituximab therapy to maintain
disease remission.
from 15th Paediatric Rheumatology European Society (PreS) Congress
London, UK. 14–17 September 2008
Published: 15 September 2008
Pediatric Rheumatology 2008, 6(Suppl 1):P237 doi:10.1186/1546-0096-6-S1-P237
<supplement> <title> <p>15<sup>th </sup>Paediatric Rheumatology European Society (PreS) Congress</p> </title> <editor>Wietse Kuis, Patricia Woo, Angelo Ravelli, Hermann Girschick, Michaël Hofer, Johannes Roth, Rotraud K Saurenmann, Alberto Martini, Pavla Dolezova, Janjaap van der Net, Pierre Quartier, Lucy Wedderburn and Jan Scott</editor> <note>Meeting abstracts – A single PDF containing all abstracts in this Supplement is available <a href="http://www.biomedcentral.com/content/files/PDF/1546-0096-6-S1-full.pdf">here</a>.</note> </supplement>
This abstract is available from: http://www.ped-rheum.com/content/6/S1/P237
© 2008 Miettunen et al; licensee BioMed Central Ltd. 


Miettunen PM

Hamiwka LA

Wade AW

Midgley JP

Grisaru S

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Effective use of rituximab in combination with low dose cyclophosphamide in childhood onset systemic lupus erythematosus (SLE) with relapsing class IV nephritis

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