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Daratumumab + rituximab is a combination of two monoclonal antibodies used off-label for the treatment of certain immune-mediated and refractory diseases, such as multidrug-resistant nephrotic syndrome and posttransplant recurrent focal segmental glomerulosclerosis. Daratumumab targets CD38, a glycoprotein highly expressed on plasma cells, leading to their depletion through mechanisms including antibody-dependent cellular cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC), antibody-dependent cellular phagocytosis (ADCP), and induction of apoptosis. Rituximab targets CD20 on B lymphocytes, resulting in B-cell depletion primarily via ADCC and CDC. The rationale for combining these agents is to target both mature B cells (via anti-CD20) and long-lived plasma cells (via anti-CD38), aiming for more comprehensive immunosuppression in refractory conditions[1][3][4][8].
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