Introduction: Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is a chronic glomerular disease caused by monoclonal gammopathy. Daratumumab has been proved effective in the treatment of plasma cell myeloma while its effect for PGNMID has rarely been reported.
Methods: A Daratumumab combination therapy (D-VCd regimen, specifically are Daratumumab + Dexamethasone + Bortezomib + Cyclophosphamide) was adopted to treat a patient diagnosed with PGNMID with glomerular deposits mainly composed of κ-light chain ( κ-light chain restricted PGNMID).
Results: The utility of D-VCd regimen showed a favorable effect in this patient. After the fixed course, his clinical symptom, laboratory parameters, neoplastic plasma cells clonity all restored to normal range, and no obvious disease progression was observed throughout the treatment. Following the treatment, 24H microalbuminuria, 24H urine total protein levels restored from 6142.35 and 9114.7mg/24h to 117 and 212mg/24h, respectively. Urinal IgG titers transformed from 129mg/L to 6.3mg/L. Urinary κ and λ -light light-chain decreased from 49.6 and 31.7mg/L to 7 and 3.9mg/L, respectively. All the while serum creatinine fluctuated within the normal range.
Conclusion: This case underscores the utility of Daratumumab in treatment of PGNMID, and it's inferred that Daratumumab has clinical effects in the disease primarily through targeting tumor clonity. However, data on the use of Daratumumab in clinical trials of PGNMIDs is currently so limited that that more experiments are needed to support the inference.
No relevant conflicts of interest to declare.
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