Efficacy of combined rituximab and daratumumab treatment in posttransplant recurrent focal segmental glomerulosclerosis

Anti-Plasma Cell Antibodies: A New Era of HLA Antibody Control in Solid Organ Transplantation?

New therapies directed against plasma cells such as anti-CD38 antibodies and the bispecific anti-BCMA antibodies, respresent not only an important advance in the treatment of multiple myeloma but have the potential to change the treatment landscape of other antibody-mediated diseases. In solid organ transplantation, the therapeutic armamentarium targeting humoral alloimmune responses in desensitization of highly sentized transplant candidates and post-transplant antibody mediated rejection has lagged behind advances in preventing and treating T cell-mediated rejection. IVIg and plasmapheresis are used extensively but have limited efficacy. Currently available anti-CD20 antibodies are only partially effective in achieving B cell depletion, and leave mature plama cells untouched. While interleukin 6 plays an important role in the humoral alloimmune response and injury, the benefits of IL-6 inhibitions have failed to be demonstrated in clinical trials. Even proteosome inhibitors developed specifically to target plasma cells have not fulfilled their promise, due to limited efficacy as single agents. This review focuses on the recent experience with, and potential applicability of, anti-CD38 antibodies in the field of organ transplantation and experimental data supporting their use and development for HLA desensitization and antibody-mediated rejection.