Membranous Nephropathy Associated with Donor Lymphocyte Infusion Following Allogeneic Bone Marrow Transplantation

Overview

Journal Int J Hematol

Specialty Hematology

Date 2003 Nov 8

PMID 14604287

Citations 7

Authors

Yasuhiko Miyazaki

Yasukiyo Mori

Noriko Kishimoto

Noriaki Matsumoto

Katsuhiro Zen

Ryuichi Amakawa

Yuji Kishimoto

Shirou Fukuhara

Affiliations

Soon will be listed here.

Abstract

Nephrotic syndrome after hematopoietic stem cell transplantation (HSCT) followed by donor lymphocyte infusion (DLI) has never been described. We report the case of a myelodysplastic syndrome (MDS) patient who developed nephrotic syndrome with membranous nephropathy 18 months after allogeneic HSCT and 4 months after DLI. A 50-year-old woman with MDS underwent allogeneic bone marrow transplantation from her HLA-matched brother. MDS relapsed 55 days after transplantation, donor lymphocytes were infused as adoptive immunotherapy, and complete remission was achieved. Four months after the third DLI, the patient developed nephrotic syndrome with proteinuria up to 9 g/day. Renal biopsy revealed granular deposits of immunoglobulin G along the glomerular basement membrane, and subepithelial electron-dense deposits. A diagnosis of membranous nephropathy was made. For maintenance of the immunotherapeutic effect of DLI, minimum doses of immunosuppressive therapy for decreasing proteinuria were administered, and improvement of nephrotic syndrome and persistent complete remission of MDS were achieved.

Citing Articles

Chronic kidney disease after autologous stem cell transplantation: analysis of a single center experience.

Wu Q, Li X, Lai Y, Peng Z, Liao Y Int Urol Nephrol. 2014; 46(7):1403-10.

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A boy with membranous nephropathy after allogeneic bone marrow transplantation.

Motoyama O, Uchino Y, Tokuyama M, Iitaka K, Ohara A Clin Exp Nephrol. 2009; 13(5):508-511.

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Focal segmental glomerulosclerosis as a complication of graft-versus-host disease.

Fofi C, Barberi S, Stoppacciaro A, Punzo G, Mene P Nat Rev Nephrol. 2009; 5(4):236-40.

PMID: 19322189 DOI: 10.1038/nrneph.2009.11.

Target antigens and nephritogenic antibodies in membranous nephropathy: of rats and men.

Ronco P, Debiec H Semin Immunopathol. 2007; 29(4):445-58.

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A young woman with oedema.

Lazzeri E, Netti G, Mazzinghi B, Cirami C, Salvadori M, Romagnani P Intern Emerg Med. 2006; 1(3):209-15.

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References

Barbara J, Thomas A, Smith P, Gillis D, Ho J, Woodroffe A . Membranous nephropathy with graft-versus-host disease in a bone marrow transplant recipient. Clin Nephrol. 1992; 37(3):115-8. View

Suehiro T, Masutani K, Yokoyama M, Tokumoto M, Tsuruya K, Fukuda K . Diffuse proliferative glomerulonephritis after bone marrow transplantation. Clin Nephrol. 2002; 58(3):231-7. DOI: 10.5414/cnp58231. View

Kimura S, Horie A, Hiki Y, Yamamoto C, Suzuki S, Kuroda J . Nephrotic syndrome with crescent formation and massive IgA deposition following allogeneic bone marrow transplantation for natural killer cell leukemia/lymphoma. Blood. 2003; 101(10):4219-21. DOI: 10.1182/blood-2002-07-2290. View

Oliveira J, Bahia D, Franco M, BALDA C, Stella S, Kerbauy J . Nephrotic syndrome as a clinical manifestation of graft-versus-host disease (GVHD) in a marrow transplant recipient after cyclosporine withdrawal. Bone Marrow Transplant. 1999; 23(1):99-101. DOI: 10.1038/sj.bmt.1701527. View

Nakao S . Identification of novel minor histocompatibility antigens responsible for graft-versus-leukemia (GVL) effect on chronic myeloid leukemia: usefulness of determining the clonotype of T cells associated with GVL effect after donor leukocyte infusion. Int J Hematol. 2002; 76 Suppl 1:274-6. DOI: 10.1007/BF03165261. View

Shiobara S, Nakao S, Ueda M, Yamazaki H, Takahashi S, Asano S . Donor leukocyte infusion for Japanese patients with relapsed leukemia after allogeneic bone marrow transplantation: indications and dose escalation. Ther Apher. 2001; 5(1):40-5. DOI: 10.1046/j.1526-0968.2001.005001040.x. View

Hiesse C, Goldschmidt E, Santelli G, Charpentier B, Machover D, Fries D . Membranous nephropathy in a bone marrow transplant recipient. Am J Kidney Dis. 1988; 11(2):188-91. DOI: 10.1016/s0272-6386(88)80211-7. View

HIKI Y, Kobayashi Y, Itoh I, Kashiwagi N . Strong association of HLA-DR2 and MT1 with idiopathic membranous nephropathy in Japan. Kidney Int. 1984; 25(6):953-7. DOI: 10.1038/ki.1984.116. View

Rossi L, Cardarelli F, Vampa M, Buzio C, Olivetti G . Membranous glomerulonephritis after haematopoietic cell transplantation for multiple myeloma. Nephron. 2001; 88(3):260-3. DOI: 10.1159/000045999. View

10.

Marks D, Lush R, Cavenagh J, Milligan D, Schey S, Parker A . The toxicity and efficacy of donor lymphocyte infusions given after reduced-intensity conditioning allogeneic stem cell transplantation. Blood. 2002; 100(9):3108-14. DOI: 10.1182/blood-2002-02-0506. View

11.

Sato N, Kishi K, Yagisawa K, Kasama J, Karasawa R, Shimada H . Nephrotic syndrome in a bone marrow transplant recipient with chronic graft-versus-host disease. Bone Marrow Transplant. 1995; 16(2):303-5. View

12.

Lin J, Markowitz G, Nicolaides M, Hesdorffer C, Appel G, DAgati V . Membranous glomerulopathy associated with graft-versus-host disease following allogeneic stem cell transplantation. Report of 2 cases and review of the literature. Am J Nephrol. 2001; 21(5):351-6. DOI: 10.1159/000046273. View

13.

Shiobara S, Nakao S, Ueda M, Yamazaki H, Takahashi S, Asano S . Donor leukocyte infusion for Japanese patients with relapsed leukemia after allogeneic bone marrow transplantation: lower incidence of acute graft-versus-host disease and improved outcome. Bone Marrow Transplant. 2000; 26(7):769-74. DOI: 10.1038/sj.bmt.1702596. View

14.

Akar H, Keven K, Celebi H, Orhan D, Nergizoglu G, Erbay B . Nephrotic syndrome after allogeneic peripheral blood stem cell transplantation. J Nephrol. 2002; 15(1):79-82. View