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Abstract: SA-PO132

Clinical Characteristics and Outcomes of Membranous Nephropathy Post Stem Cell Transplant

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Klomjit, Nattawat, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, United States
  • Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Alexander, Mariam P., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Leung, Nelson, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

Glomerulonephritis is rare but one of the important causes of kidney injury in patients with stem cell transplant (SCT). Membranous nephropathy (MN) is the most common etiology but data regarding clinical characteristics and outcomes of these patients are limited.

Methods

We included all patients who developed MN post SCT between 2000-2021 from the Mayo Clinic Health System and University of Minnesota. Baseline demographics and pertinent clinical outcomes are collected.

Results

Between 2000 to 2021, we identified 16 patients (13 from Mayo Clinic and 3 from University of Minnesota). The median age at the time of SCT and MN diagnosis was 57.1 (21.8-68.4) and 63 (25.7-70.2) years respectively. The most common hematological disease was acute leukemia (62.5%), lymphoma (12.5%), multiple myeloma (6.25%) and other. The median time from SCT to MN diagnosis was 2.6 (1.5-20.8) years. About two-third of patients were female and all were white. Patients typically presented with nephrotic syndrome (13/16, 81.3%). The median serum creatinine was 1.2 (ranged 0.5-4.0) mg/dL with median urine protein 6.6 (ranged 2.0-40.0) g/d. Nearly all patients developed graft-versus-host disease (GVHD) (15/16, 93.8%) with skin manifestation as the most common site (10/15, 66.7%). One patient had PLA2RAb. Of 16 patients, 10 (62.5%) received rituximab (RTX), 5 (31.3%) received other immunosuppression (mycophenolate mofetil, prednisone, cyclosporine and tacrolimus), and 1 (6.2%) did not receive therapy. The median follow-up time was 2.7 (0.2-20.9) years. Twelve patients (75%) achieved complete remission with a median time to remission of 8 (ranged 3-12) months. Eighty percent of RTX and 66.6% of non-RTX group achieved complete remission (p=0.7). Four patients initially did not respond to non-RTX regimen and subsequently RTX was added, resulting in CR in all cases. Three patients relapsed (1 RTX and 2 non-RTX).

Conclusion

MN post-SCT typically occur in patients with concomitant GVHD. Patients often respond to immunosuppression and achieve CR relatively quickly compared to MN in non-SCT patients. RTX therapy may portend better outcome compared to other immunosuppression. Future studies are needed to assess the efficacy of RTX.