. 2026 Feb 23;41(9):2799–2823. doi: 10.1007/s00467-026-07180-2

Table 8.

Practice points for minimising risk of infection for anti-CD20 mAbs in paediatric kidney diseases

Practice Points
1) Pre therapy assessment and immunisation: o Detailed evaluation on the medical history, review the indications of anti-CD20 mAbs, concurrent use of immunosuppressants, vaccination history, and travel history o Screen for active/latent infections (see Table 4), consult infectious disease specialists for complex cases o Administer necessary vaccines 2–4 weeks before anti-CD20 mAbs 2) If vaccination cannot be completed before anti-CD20 mAbs: o Surveillance for infections o Re-vaccinate at an appropriate interval after the last anti-CD20 mAbs administration, considering B-cell reconstitution 3) After anti-CD20 mAbs: o Adjust and minimise concurrent immunosuppression o Monitor complete blood count for neutropenia and agranulocytosis (may require GCSF treatment) o Antimicrobial prophylaxis (preferably cotrimoxazole if no G6PD deficiency) against Pneumocystis jirovecii pneumonia ≥ 6 months, may be extended until B-cell reconstitution o For children with persistent hypogammaglobulinaemia and recurrent or severe infections, consider prophylactic immune globulin (either intravenous or subcutaneous) o CMV prophylaxis in moderate- to high-risk transplant recipients for 3–6 months o Promote seasonal influenza vaccination (see Table 5 for caution) 4) Comprehensive education of patients and their families o Infection prevention strategies o Monitor for signs and symptoms of infection for early intervention

Practice Points

1) Pre therapy assessment and immunisation:

o Detailed evaluation on the medical history, review the indications of anti-CD20 mAbs, concurrent use of immunosuppressants, vaccination history, and travel history

o Screen for active/latent infections (see Table 4), consult infectious disease specialists for complex cases

o Administer necessary vaccines 2–4 weeks before anti-CD20 mAbs

2) If vaccination cannot be completed before anti-CD20 mAbs:

o Surveillance for infections

o Re-vaccinate at an appropriate interval after the last anti-CD20 mAbs administration, considering B-cell reconstitution

3) After anti-CD20 mAbs:

o Adjust and minimise concurrent immunosuppression

o Monitor complete blood count for neutropenia and agranulocytosis (may require GCSF treatment)

o Antimicrobial prophylaxis (preferably cotrimoxazole if no G6PD deficiency) against Pneumocystis jirovecii pneumonia ≥ 6 months, may be extended until B-cell reconstitution

o For children with persistent hypogammaglobulinaemia and recurrent or severe infections, consider prophylactic immune globulin (either intravenous or subcutaneous)

o CMV prophylaxis in moderate- to high-risk transplant recipients for 3–6 months

o Promote seasonal influenza vaccination (see Table 5 for caution)

4) Comprehensive education of patients and their families

o Infection prevention strategies

o Monitor for signs and symptoms of infection for early intervention