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

Bone Marrow Transplantation volume 50, pages 449–451 (2015)Cite this article

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Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment for advanced malignant and select benign hematopoietic disorders. Chronic GVHD (cGVHD) develops in 50–80% of recipients and remains a major cause of post-HCT morbidity and mortality.1, 2 The development of acute and chronic renal insufficiency has been increasingly recognized as a complication of allo-HCT. Renal disease can be seen early or late after allo-HCT and has many potential etiologies but renal dysfunction as a consequence of cGVHD is uncommon. Murine models support an etiologic relationship between GVHD and the development of renal disease. Injection of DBA/2 donor murine lymphocytes into F1 hybrid mice produces a murine model of GVHD associated with heavy proteinuria.3 Clinical case reports and case series have documented nephrotic range proteinuria (NRP) after allo-HCT in humans.4

We conducted a retrospective study in all patients who underwent allo-HCT between 2005 and 2011 at our institution and subsequently developed NRP. NRP was defined as presence of ⩾3 g of protein in a 24 h urine specimen (Brenner’s and Rector’s, The Kidney, 9th edition). It is our institutional policy to screen allo-HCT recipients for development of NRP with 24 h urine protein if they develop unexplained peripheral edema, generalized swelling, hypoalbuminemia or decrease in renal function. All patients included in this report received uniform acute GVHD prophylaxis with MTX and tacrolimus.

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Authors and Affiliations

  1. Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    B Dhakal, J Palmer, A D'Souza, M Hamadani & P N Hari

  2. Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    A Singavi

  3. Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA

    E P Cohen, M Dangal & A Dall

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  1. B Dhakal
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Correspondence to P N Hari.

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Competing interests

MH received research funding from Millennium and Consultancy to Cellerant and MedImmune and Honorarium from Celgene. PH has been consultant to Sanofi and received research funding from them. The remaining authors declare no conflict of interest.

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Dhakal, B., Singavi, A., Cohen, E. et al. Chronic GVHD and concurrent new-onset nephrotic syndrome in allogeneic transplant recipients. Incidence, pattern and therapeutic outcomes. Bone Marrow Transplant 50, 449–451 (2015). https://doi.org/10.1038/bmt.2014.261

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