title: Membranous nephropathy in autologous hematopoietic stem cell transplant: autologous graft-versus-host disease or autoimmunity induction?
abstract: With the increasing utility of hematopoietic stem cell transplantation (SCT) as a treatment for cancer and noncancerous disorders, more challenges and complications associated with SCT have emerged. Renal injury immediately after transplant is common and well understood, but long-term renal injury is becoming more evident. Chronic graft-versus-host disease (GVHD) is a known long-term complication of SCT, and membranous nephropathy (MN) is emerging as the most common cause of SCT-associated glomerular pathology. In this case report, we present a patient who developed features of anti-PLA2R antibody-negative MN following autologous SCT. The renal injury responded well to steroids and further response to rituximab therapy was noted, suggesting antibody-mediated autoimmune glomerular disease. We also present a review of the literature on autologous GVHD and the role of T and B cells in induction of autoimmunity by SCT.
authors.affiliation: Division of Internal Medicine, Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston , TX , USA.
authors.forename: Ala
authors.initials: A
authors.lastname: Abudayyeh
authors.affiliation: Department of Pathology and Genomic Medicine , The Houston Methodist Hospital, Houston , TX , USA.
authors.forename: Luan D
authors.initials: LD
authors.lastname: Truong
authors.affiliation: Department of Medicine, Section of Nephrology , Boston University School of Medicine, Boston , MA , USA.
authors.forename: Laurence H
authors.initials: LH
authors.lastname: Beck
authors.affiliation: Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center, Houston , TX , USA.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Weber
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center , Houston , TX , USA.
authors.forename: Katy
authors.initials: K
authors.lastname: Rezvani
authors.affiliation: Division of Medical Oncology, Duke University Medical Center , Durham, North Carolina , USA.
authors.forename: Maen
authors.initials: M
authors.lastname: Abdelrahim
keywords: GVHD; anti-PLA2R; autologous stem cell transplant; membranous nephropathy