Bortezomib Successfully Reverses Early Recurrence of Light-Chain Deposition Disease in a Renal Allograft: A Case Report

Káposztás, Zsolt; Kahan, B.; Katz, S. M.; Buren, Charles T. Van; Cherem, L.

doi:10.1016/j.transproceed.2009.10.005

Cited by 33 publications

(22 citation statements)

References 29 publications

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“…Preliminary results suggest that bortezomibbased regimens could produce hematologic response rates similar to those obtained with HDM/ASCT, as is the case in MM. [72][73][74][75][76][77] Taking into account these points, therapeutic recommendations should be based on the degree of renal impairment:…”

Section: 57mentioning

confidence: 99%

How I treat monoclonal gammopathy of renal significance (MGRS)

Fermand¹,

Bridoux²,

Kyle

et al. 2013

Blood

277

220

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Recently, the term monoclonal gammopathy of renal significance (MGRS) was introduced to distinguish monoclonal gammopathies that result in the development of kidney disease from those that are benign. By definition, patients with MGRS have B-cell clones that do not meet the definition of multiple myeloma or lymphoma. Nevertheless, these clones produce monoclonal proteins that are capable of injuring the kidney resulting in permanent damage. Except for immunoglobulin light chain amyloidosis with heart involvement in which death can be rapid, treatment of MGRS is often indicated more to preserve kidney function and prevent recurrence after kidney transplantation rather than the prolongation of life. Clinical trials are rare for MGRS-related kidney diseases, except in immunoglobulin light chain amyloidosis. Treatment recommendations are therefore based on the clinical data obtained from treatment of the clonal disorder in its malignant state. The establishment of these treatment recommendations is important until data can be obtained by clinical trials of MGRS-related kidney diseases.

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Section: 57mentioning

confidence: 99%

How I treat monoclonal gammopathy of renal significance (MGRS)

Fermand¹,

Bridoux²,

Kyle

et al. 2013

Blood

277

220

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“…Preliminary results have shown the possibility of preventing an early recurrence of LCDD with the proteasome inhibitor bortezomib (66) or with rituximab (67). The best current therapeutic approach is chemotherapy and autologous stem cell transplantation followed by kidney transplantation in case of good hematologic response (68).…”

Section: Light-chain Deposition Diseasementioning

confidence: 99%

Recurrence of Secondary Glomerular Disease after Renal Transplantation

Ponticelli¹,

Moroni

Glassock

2011

Clinical Journal of the American Society of Nephrology

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SummaryThe risk of a posttransplant recurrence of secondary glomerulonephritis (GN) is quite variable. Histologic recurrence is frequent in lupus nephritis, but the lesions are rarely severe and usually do not impair the longterm graft outcome. Patients with Henoch-Schonlein nephritis have graft survival similar to that of other renal diseases, although recurrent Henoch-Schonlein nephritis with extensive crescents has a poor prognosis. Amyloid light-chain amyloidosis recurs frequently in renal allografts but it rarely causes graft failure. Amyloidosis secondary to chronic inflammation may also recur, but this is extremely rare in patients with Behcet's disease or in those with familial Mediterranean fever, when the latter are treated with colchicine. Double organ transplantation (liver/kidney; heart/kidney), chemotherapy, and autologous stem cell transplantation may be considered in particular cases of amyloidosis, such as hereditary amyloidosis or multiple myeloma. There is little experience with renal transplantation in light-chain deposition disease, fibrillary/ immunotactoid GN, or mixed cryoglobulinemic nephritis but successful cases have been reported. Diabetic nephropathy often recurs but usually only after many years. Recurrence in patients with small vessel vasculitis is unpredictable but can cause graft failure. However, in spite of recurrence, patient and graft survival rates are similar in patients with small vessel vasculitis compared with those with other renal diseases. Many secondary forms of GN no longer represent a potential contraindication to renal transplantation. The main issues in transplantation of patients with secondary GN are the infectious, cardiovascular, or hepatic complications associated with the original disease or its treatment.

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“…[11][12][13][14][15] More recently, several groups have shown encouraging results with high-dose melphalan followed by autologous stem cell transplantation (HDM/ ASCT), 16 and anecdotal case reports have suggested the efficacy of the proteasome inhibitor bortezomib on renal and patient outcomes in LCDD and HCDD. [17][18][19][20][21][22] Although recent recommendations advocated the use of bortezomib as firstline treatment in MIDD, 10 the efficacy and safety of novel anti-myeloma agents have not been evaluated so far. To this aim, we retrospectively reviewed 49 patients with biopsyproven MIDD treated with bortezomib-based combinations.…”

mentioning

confidence: 99%

Bortezomib produces high hematological response rates with prolonged renal survival in monoclonal immunoglobulin deposition disease

Cohen

Royer

Javaugue

et al. 2015

Kidney International

114

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Monoclonal immunoglobulin deposition disease (MIDD) is a rare complication of plasma cell disorders, defined by linear Congo red-negative deposits of monoclonal light chain, heavy chain, or both along basement membranes. While renal involvement is prominent, treatment strategies, such as the impact of novel anti-myeloma agents, remain poorly defined. Here we retrospectively studied 49 patients with MIDD who received a median of 4.5 cycles of intravenous bortezomib plus dexamethasone. Of these, 25 received no additional treatment, 18 also received cyclophosphamide, while 6 also received thalidomide or lenalidomide. The hematological diagnoses identified 38 patients with monoclonal gammopathy of renal significance, 10 with symptomatic multiple myeloma, and 1 with Waldenstrom macroglobulinemia. The overall hematologic response rate, based on the difference between involved and uninvolved serum-free light chains (dFLCs), was 91%. After median follow-up of 54 months, 5 patients died and 10 had reached end-stage renal disease. Renal response was achieved in 26 patients, with a 35% increase in median eGFR and an 86% decrease in median 24-h proteinuria. Predictive factors were pre-treatment eGFR over 30 ml/min per 1.73 m(2) and post-treatment dFLC under 40 mg/l; the latter was the sole predictive factor of renal response by multivariable analysis. Thus, bortezomib-based therapy is a promising treatment strategy in MIDD, mainly when used early in the disease course. dFLC response is a favorable prognostic factor for renal survival.

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Bortezomib Successfully Reverses Early Recurrence of Light-Chain Deposition Disease in a Renal Allograft: A Case Report

Cited by 33 publications

References 29 publications

How I treat monoclonal gammopathy of renal significance (MGRS)

How I treat monoclonal gammopathy of renal significance (MGRS)

Recurrence of Secondary Glomerular Disease after Renal Transplantation

Bortezomib produces high hematological response rates with prolonged renal survival in monoclonal immunoglobulin deposition disease

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