Kidney Week

Abstract: PO1939

Patients with Active Mantle Cell Lymphoma May Present with Monoclonal, Polyclonal, or C3-Dominant Glomerulonephritides, Which Respond to Lymphoma-Directed Therapy

Session Information

• Renal Pathology: From Laboratory to Bedside
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

• 1600 Pathology and Lab Medicine

Authors

• Andeen, Nicole K., Oregon Health & Science University, Portland, Oregon, United States

Nicole K. Andeen, MD

• Abdulameer, Shahad, University of Washington, Seattle, Washington, United States

Shahad Abdulameer,

• Charu, Vivek, Stanford University, Stanford, California, United States

Vivek Charu,

• Zuckerman, Jonathan E., University of California Los Angeles, Los Angeles, California, United States

Jonathan E. Zuckerman,

• Troxell, Megan L., Stanford University, Stanford, California, United States

Megan L. Troxell,

• Kambham, Neeraja, Stanford University, Stanford, California, United States

Neeraja Kambham,

• Alpers, Charles E., University of Washington, Seattle, Washington, United States

Charles E. Alpers,

• Najafian, Behzad, University of Washington, Seattle, Washington, United States

Behzad Najafian,

• Nicosia, Roberto F., University of Washington, Seattle, Washington, United States

Roberto F. Nicosia,

• Smith, Kelly D., University of Washington, Seattle, Washington, United States

Kelly D. Smith,

• Kung, Vanderlene Liu, Oregon Health & Science University, Portland, Oregon, United States

Vanderlene Liu Kung,

• Avasare, Rupali S., Oregon Health & Science University, Portland, Oregon, United States

Rupali S. Avasare,

• Yamashita, Michifumi, Cedars-Sinai Medical Center, Los Angeles, California, United States

Michifumi Yamashita,

• Bissonnette, Mei Lin, The University of British Columbia, Vancouver, British Columbia, Canada

Mei Lin Bissonnette,

• Akilesh, Shreeram, University of Washington, Seattle, Washington, United States

Shreeram Akilesh,

• Hou, Jean, Cedars-Sinai Medical Center, Los Angeles, California, United States

Jean Hou,

Background

There are limited reports on kidney biopsy findings in patients with mantle cell lymphoma (MCL).

Methods

We initiated a multi-institutional, retrospective review of kidney biopsy findings from patients with active and treated MCL.

Results

Twenty-nine patients (31 biopsies) with MCL and kidney biopsies were identified, with a median age of 66 (range 48-87), 76% of whom were men. Nineteen patients had active MCL at the time of biopsy, 13 of which (68%) presented with acute kidney injury, proteinuria and/or hematuria, and biopsy findings attributable to lymphoma (Table); 6 (32%) had findings not readily attributable to MCL. Of the former, 10 (77%) had immune complex (IC) disease including proliferative glomerulonephritis with monotypic Ig deposits (PGNMID, 2), C3 dominant GN (3), PLA2R-negative membranous (MN, 3), and/or tubular basement membrane deposits (2). Lymphomatous infiltration was present in 6, 3 with coincident IC lesions. Four with available follow-up were treated for MCL, all with remission of GN (1 PGNMID, 2 C3 dominant GN, 1 MN). Ten patients were biopsied while MCL was in remission; these findings were attributed to various underlying diseases.

Conclusion

In patients with active MCL who undergo kidney biopsy, 68% had kidney biopsy findings attributable to lymphoma. Diverse immune complex diseases were seen in ~50%, including monoclonal, polyclonal, and C3 dominant GN patterns, and nearly 1/3^rd had lymphomatous infiltration. Limited follow-up suggests these IC lesions respond to MCL-directed therapy.