Abstract
Background: membranous glomerulopathy (MG) is an immunomediated disorder which accounts for the most common cause of nephrotic syndrome (NS) following allogeneic hematopoietic stem cell transplantation (HSCT).
Objective and Methods: to provide an update on the issue by reviewing pertinent literature on the MEDLINE database.
Results: sixty-nine post allogenic HSCT patients (42 male) with MG were identified. The median age was 43 (5 to 68) years. Time interval from allogenic HSCT to MG diagnosis ranged from 3 to 134 months (median 17). Most MG patients had a history of acute (70%) or chronic (84%) graft versus host disease (GVHD). Corticosteroids and cyclosporine were the most common therapeutic agents used in this setting; alternative therapies, including rituximab, were given to a lower number of patients. Outcome data were available in 64 out of 69 MG patients; 38 (59%) and 18 (28%) patients achieved a complete and a partial response respectively, whereas treatment failure was recorded in the remaining 8 (13%).
Conclusion: MG after allogenic HSCT appears to be associated with a sub clinical or overt cGVHD, which follows the discontinuation of immunosuppressive prophylaxis. Although a standard therapeutic approach has not been established, the application of available measures can induce favorable response in more than 80% of affected patients, but treatmentfailure and progressive deterioration of the renal function may occur in about one fifth of cases.
Keywords: Allogeneic hematopoietic stem cell transplantation, chemotherapy, conditioning regimen, corticostroids, cyclosporine, glomerulonephritis, graft-versus-host disease, leukemia, lymphoma, membranous glomerulopathy, multiple myeloma, nephrotic syndrome, radiotherapy, renal failure, rituximab
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