1. ¹Blood and Marrow Transplantation Program, Division of Hematology-Oncology, Department of Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
2. ²Department of Pathology, University of Michigan Medical Center, Ann Arbor, MI, USA
3. ³Hematopoietic Stem Cell Transplantation Program, Karmanos Cancer Center, Wayne State University, Detroit, MI, USA
4. ⁴Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA

Correspondence: Dr P Reddy, Blood and Marrow Transplantation Program, University of Michigan Cancer Center, 6310 CCGC, 1500 E Med Ctr Dr, Ann Arbor, MI 48109, USA. E-mail: reddypr@umich.edu

Received 23 March 2006; Revised 8 June 2006; Accepted 10 June 2006; Published online 24 July 2006.

Abstract

Chronic graft-versus-host disease (cGVHD) is the most common late complication of allogeneic hematopoietic cell transplantation (HCT) causing significant morbidity and mortality. The kidneys are not considered a target organ for cGVHD in humans, although animal models show renal damage. Renal involvement in patients with cGVHD, presenting as nephrotic syndrome (NS), has rarely been reported in patients who received allogeneic transplantation. Herein we describe, by far, the largest series of nine patients with NS associated with cGVHD, including two patients who received a reduced-intensity regimen. Pathological features of membranous nephropathy were the most common finding on renal biopsy. The clinical course of the NS was temporally associated with the classical features of cGVHD in all but one of the nine cases. The clinicopathologic features of NS in our series as well as reports in the literature demonstrate an immunopathologic process typical of antibody-mediated damage consistent with cGVHD. Treatment directed against antibody-mediated damage, such as anti-B-cell antibody may play an important role in ameliorating NS associated with cGVHD.