Chronic GVHD and concurrent new-onset nephrotic syndrome in allogeneic transplant recipients. Incidence, pattern and therapeutic outcomes

Dhakal, Binod; Singavi, Arun; Cohen, Eric P.; Dangal, M; Palmer, Jeanne; Dall, Aaron; D’Souza, Anita; Hamadani, Mehdi; Hari, Parameswaran

doi:10.1038/bmt.2014.261

Cited by 12 publications

(11 citation statements)

References 16 publications

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“…NS is an uncommon complication of allo‐HSCT, with a reported incidence of 1–4.3% . Descriptions in the literature are limited to case reports and small case series.…”

Section: Case Series Of Nephrotic Syndrome After Allo‐hsct In the Litmentioning

confidence: 99%

“…Descriptions in the literature are limited to case reports and small case series. A literature search using the PubMed database with search terms ‘NS’, ‘renal failure’ and ‘haemopoietic transplant’ for publications in the English language since the year 2000 identified 10 case series (Table ) and 15 case reports, with a combined total of 67 cases. A pooled analysis was performed to identify key characteristics of this syndrome.…”

Section: Case Series Of Nephrotic Syndrome After Allo‐hsct In the Litmentioning

confidence: 99%

“…described responses in seven out of eight patients who received corticosteroids; however, Dhakal et al . reported the resolution of proteinuria in only one case treated with prednisolone alone, with eight patients requiring additional immunosuppression …”

Section: Case Series Of Nephrotic Syndrome After Allo‐hsct In the Litmentioning

confidence: 99%

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Nephrotic syndrome as a complication of chronic graft‐versus‐host disease after allogeneic haemopoietic stem cell transplantation

Wong

Lasica

et al. 2016

Internal Medicine Journal

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Nephrotic syndrome (NS) is a rare complication following allogeneic haemopoietic stem cell transplantation (allo-HSCT), with limited current understanding of its pathogenesis. Here, we describe four cases of NS following allo-HSCT diagnosed at our institutions to identify key clinical and pathological features. In addition, a PubMed search was performed to identify existing reports that were pooled together with our cases for analysis. NS occurred as a late complication following allo-HSCT, with median onset 19.5 months after transplant (range: 3.9-84 months). The most common histopathology observed was membranous nephropathy; however, cases of minimal change disease have also been reported. There is a high incidence of prior extra-renal graft-versus-host disease (GvHD), with all four of our cases and 82% of published cases having prior GvHD. Glucocorticosteroids are the most common treatment, with variable degrees of response. Responses to immunosuppression with calcineurin inhibitors and rituximab have been described in steroid-refractory cases.

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“…NS is an uncommon complication of allo‐HSCT, with a reported incidence of 1–4.3% . Descriptions in the literature are limited to case reports and small case series.…”

Section: Case Series Of Nephrotic Syndrome After Allo‐hsct In the Litmentioning

confidence: 99%

Section: Case Series Of Nephrotic Syndrome After Allo‐hsct In the Litmentioning

confidence: 99%

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Nephrotic syndrome as a complication of chronic graft‐versus‐host disease after allogeneic haemopoietic stem cell transplantation

Wong

Lasica

et al. 2016

Internal Medicine Journal

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“…In contrast, post-HCT MCD is frequently glucocorticoid-resistant, with a response rate of approximately 22% [ 9 ]. The remaining patients require combination therapy with calcineurin inhibitors, mycophenolate mofetil, or rituximab [ 11 , 12 , 13 , 14 , 15 ]. Likewise, post-HCT MN tends to be resistant to glucocorticoids, with response rates comparable to those seen in idiopathic MGN, approximately 11% [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Minimal Change Disease Secondary to Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplant for Myelodysplastic Syndrome

Elghawy

Wang

Hafey

et al. 2022

Case Rep Nephrol Dial

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Chronic graft-versus-host disease (cGVHD) is a leading cause of non-relapse mortality in allogeneic hematopoietic cell transplant (HCT) recipients. While the current standard of care is proactive in detecting cGVHD in the lungs, liver, and skin, cGVHD involving kidneys is an underrecognized and likely underdiagnosed cause of post-HCT renal dysfunction. Nephrotic syndrome (NS) is a very rare complication of HCT that is postulated to be a glomerular manifestation of cGVHD. Herein, we report 2 cases of post-HCT minimal change disease likely secondary to cGVHD. In both cases, the onset of NS coincided with tapering of calcineurin inhibitors, and 1 patient had previously been diagnosed with cGVHD of the lungs. One patient was treated with corticosteroids alone and the other with a corticosteroids and tacrolimus. Complete, sustained remission was achieved in both cases. Our cases illustrate the implications of the association between cGVHD and post-HCT NS for patient care, including the importance of obtaining a renal biopsy to establish an accurate histopathological diagnosis and guide-appropriate treatment.

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“…Although the kidney is a rare target organ in cGvHD as well as the heart, development of nephrotic range proteinuria has been recognized as a novel manifestation of cGvHD, and resolution of proteinuria with anti-CD20 antibody to support the role of B-cell dysregulation has been reported. 11 It has been appreciated that disturbances of cytokines and B-cells in cGvHD can be pathogenic without prominent inflammatory cell participation. 12 Taken together with the fact that immunosuppressive treatment is highly effective and can improve the high concentrations of cytokines and autoantibodies against the myocardium, we speculate reversible cardiomyopathy as a possible manifestation of GvHD.…”

mentioning

confidence: 99%

Very late-onset reversible cardiomyopathy in patients with chronic GvHD

Kawano

Tanaka

Yamashita

et al. 2015

Bone Marrow Transplant

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A cardiac complication with relevant short-term toxicity is uncommon, but it is one of the severe complications after allogeneic hematopoietic stem cell transplantation (HSCT). 1 Recently, there has been increased performance of HSCT; hence late complications in long-term survivors are monitored closely. However, there are only a few reports about late-onset cardiac dysfunction. A few years ago, we experienced two patients with AML and a concomitant previously unrecognized form of very late-onset reversible cardiomyopathy in our long-term follow-up program after allogeneic HSCT.The first patient is a 46-year-old man, who underwent PBSC transplantation (PBSCT) from an HLA-matched sibling after a reduced-intensity conditioning regimen (fludarabine and busulfan). Cyclosporine A was used for GvHD prophylaxis. On day 120, he developed de novo chronic GvHD (cGvHD) with oral erosions and moderate elevation of liver enzymes, which were treated with FK506. Moreover, he experienced a cryptogenic organizing pneumonitis at 9 months post HSCT, which was treated successfully with steroid. After FK506 was discontinued and steroid was tapered, severe cGvHD developed gradually within 6 years with the following scores of severity: 2 performance status (PS) 1, oral 1, skin 2, eye 2, lung 3 (bronchiolitis obliterans), gut 1, and joints and fascia 1 with prednisolone 5 mg/day. Eight years post SCT, he experienced dyspnea and lightheadedness with sinus tachycardia (115 bpm) and hypertension (169/125 mm Hg). Hypoxemia was not observed.The second patient is a 40-year-old man, who underwent PBSCT from a 5/6 HLA-matched sibling after cyclophosphamide/TBI. FK506 and mycophenolate mofetil were used for GvHD prophylaxis. Three months post PBSCT, he developed acute GvHD (liver, stage 2), which was treated successfully with steroid. After FK506 and steroid were discontinued, he developed a quiescent-type moderate cGvHD within 2 years: PS 1, eye 2 and lung 1 without any immunosuppressant drugs. Five years after SCT, annual follow-up examination incidentally revealed deterioration of heart function, although mild exertional dyspnea had developed 1 month before. He presented with sinus tachycardia (120 bpm) with blood pressure of 136/90 mm Hg.Neither patient presented with signs and symptoms of infection and ischemic heart disease. Moreover, physical examinations and plain chest X-rays revealed the absence of congestive heart failure. Laboratory studies showed no significant elevation of creatine kinase and troponin I. However, echocardiogram demonstrated severe left ventricular global hypokinesia without bradycardia and pericardial effusion (left ventricular ejection fraction: 32% for patient 1 and 22% for patient 2). Cardiac functions, including left ventricular ejection fraction, were normal during the pretransplant and post-transplant annual follow-up period. Before transplantation, there were four rounds and one cycle of chemotherapy, and the cumulative doses of anthracycline were tolerable and equivalent to 315 and 107 mg/m 2 doxorubicin, ...

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Chronic GVHD and concurrent new-onset nephrotic syndrome in allogeneic transplant recipients. Incidence, pattern and therapeutic outcomes

Cited by 12 publications

References 16 publications

Nephrotic syndrome as a complication of chronic graft‐versus‐host disease after allogeneic haemopoietic stem cell transplantation

Nephrotic syndrome as a complication of chronic graft‐versus‐host disease after allogeneic haemopoietic stem cell transplantation

Minimal Change Disease Secondary to Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplant for Myelodysplastic Syndrome

Very late-onset reversible cardiomyopathy in patients with chronic GvHD

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