Patients highly allosensitized against HLA antigen awaiting for a kidney transplant have less compatible transplants to them, increasing their waitlist time and mortality. Current desensitization strategies need to be improved with a high remaining acute rejection rate in this population and a substantial survival benefit which is not uniformly reported in the literature. The investigators propose to use daratumumab, a human IgG1 (Immunoglobulin Gamma-1) monoclonal antibody directed against the CD38 molecule (cluster of differentiation 38) witch induce response in refractory multiple myeloma by depleting plasma cells, as a new agent of desensitization. The study will address the hypothesis that daratumumab can lead to a significant decrease in calculated panel reactive antibodies by elimination of anti-HLA antibodies-producing plasma cells and facilitate the access to transplantation with a safety profile in highly sensitized patients registered in our kidney transplantation center.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
21
\- Step I: dose-escalation 3 patients treated weekly during four weeks with 4 mg/kg of daratumumab, then 3 patients treated weekly during four weeks with 8 mg/kg of daratumumab, then 3 patients treated weekly four weeks with 16 mg/kg of daratumumab
\- Step II: expansion cohort to 13 patients (with 10 new patients included and the last 3 patients from the step I) with eight weekly doses of 16 mg/kg daratumumab
Henri Mondor
Créteil, France
Serious adverse events (SAEs) and adverse event (AEs) related and unrelated to the treatment during the dose-escalation step
Time frame: up to 21 months
Intra-patient variation of cPRA after daratumumab treatment
Time frame: Baseline (Day 0) and at six months after daratumumab treatment
Patient survival within one year after inclusion
Time frame: Baseline (Day 0) and at six months after daratumumab treatment
Intra-patient variation of sum of mean fluorescence intensity (MFI) of anti-HLA antibodies
Time frame: Baseline (Day 0) and at one month, three months, six months and 12 months after daratumumab treatment.Baseline (Day 0) and at one, three, six and 12 months after daratumumab treatment.
Intra-patient variation of cPRA (calculated panel reactive antibodies) after daratumumab treatment
PRA will be calculated on serum, analyzed with Luminex single antigen assays
Time frame: Baseline (Day 0) and at one month, three months and 12 months after daratumumab treatment.
Percentage of patients engrafted
Time frame: At six months and 12 months after inclusion
Variation of immunoglobulin's blood titers
Time frame: At baseline (Day 0), three months, six months and 12 months after daratumumab treatment
Intra-patient variation of ABO antibody titers
ABO antibody titration will be performed by flow cytometry
Time frame: At baseline (Day 0), three months, six months and 12 months after daratumumab treatment
Incidence of invasive infections
Time frame: 6 months and on year after inclusion
Incidence of opportunistic infections
Time frame: 6 months and one year after inclusion
Absolute number of Blood plasma cell
Time frame: At baseline (Day 0), one month, three months , six months and 12 months after daratumumab treatment
Percentage of Blood plasma cell
Time frame: At baseline (Day 0), one month, three months , six months and 12 months after daratumumab treatment
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