Membranous Glomerulopathy as a Late Complication of Chronic Graft-Versus-Host Disease Following allogeneic Stem Cell Transplantation: A Concise Review

Niscola, Pasquale; Palumbo, Roberto; Scaramucci, Laura; Tatangelo, Paola; Cupelli, Luca; Giovannini, Marco; Massa, Pasquale; Romani, Claudio; Tendas, Andrea; Massimi, Elisabetta; Kemper, Markus J.; de Fabritiis, Paolo
July 2009
Asia Pacific Journal of Oncology & Hematology;2009, Vol. 1 Issue 2, p21
Academic Journal
Background Membranous glomerulopathy (MG) is the most frequent disease diagnosed in patients who develop nephrotic syndrome (NS) after allogeneic hematopoietic stem cell transplantation (HSCT). In such a setting, the pathogenesis of MG is not clearly understood; humoral and cellular immune-mediated mechanisms have been reported. The diagnosis of this complication should be based on renal biopsy. Objective To summarize the current knowledge on the epidemiology, pathogenesis, clinical features and treatment options in the setting of postallogenic HSCT MG and provide an update of the literature on this issue. Methods The available data on MG diagnosed in patients submitted to allogenic HSCT were identified using the MEDLINE database (last accessed: May 12, 2009). Articles retrieved in English were critically reviewed and the reported data were summarized. Results Fifty-seven posttransplant MG patients (42 male) with a median age of 43 years (5 to 68 years) were identified. MG occurred at a median time of 17 months (3 to 134 months) after allogenic HSCT. A history of acute or concomitant clinically apparent chronic graft versus host disease (GVHD) was present in 68% and 86% of cases, respectively. Chronic GVHD (cGVHD), nonmyeloablative conditioning regimens, immunosuppression withdrawal and the use of peripheral blood stem cell grafts were the identified risk factors. Most patients received corticosteroids associated with cyclosporine A and, in a lower number, several other treatments. Out of the 53 patients with available outcome data, complete remission (CR), partial response and inefficacy of treatments were recorded in 35 (66%), 11 (21%) and 7 (13%) of cases, respectively. Conclusion MG after allogenic HSCT seems to be etiologically related to subclinical or overt cGVHD which flares up after discontinuation of immunosuppression. The available measures can induce favorable sustained long-term remission in about twothirds of affected patients.


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