Aimoto Mizuki, Yamane Takahisa, Ichii Mitsuru, Mori Katsuhito, Moriguchi-Aimoto Ran, Wada-Inoue Eri, Koh Hideo, Nakane Takahiko, Takeoka Yasunobu, Akahori-Nakamae Mika, Nishiki-Kosaka Saori, Terada Yoshiki, Nakamae Hirohisa, Koh Ki-Ryang, Nakao Takafumi, Ohsawa Masahiko, Wakasa Kenichi, Ishimura Eiji, Inaba Masaaki, Hino Masayuki
Department of Hematology, Graduate School of Medicine, Osaka City University.
Rinsho Ketsueki. 2011 Jul;52(7):556-62.
A 38-year-old man was diagnosed with acute lymphoblastic leukemia. We performed myeloablative bone marrow transplantation from an unrelated donor during the patient's first complete remission. After engraftment, he developed acute graft-versus-host disease involving the gastrointestinal tract on day 32. Steroids and mycophenolate mofetil were initiated from day 39. His symptoms improved and the dose of immunosuppressants was tapered and then discontinued on day 421. On day 491, he developed nephrotic syndrome (NS). Based on renal biopsy, membranous nephropathy was diagnosed. There were no apparent symptoms or abnormal laboratory data suggestive of chronic graft-versus-host disease (cGVHD). Steroid therapy was initiated from day 518 and proteinuria improved significantly. NS is very rare following allogeneic hematopoietic stem cell transplantation (allo-HSCT). When there is no concomitant cGVHD, as in this case, allo-HSCT-associated NS is difficult to distinguish from idiopathic NS.
一名38岁男性被诊断为急性淋巴细胞白血病。在患者首次完全缓解期间，我们进行了来自无关供体的清髓性骨髓移植。移植后，他在第32天出现了累及胃肠道的急性移植物抗宿主病。从第39天开始使用类固醇和霉酚酸酯。他的症状有所改善，免疫抑制剂的剂量逐渐减少，并于第421天停药。在第491天，他出现了肾病综合征（NS）。根据肾活检，诊断为膜性肾病。没有明显症状或异常实验室数据提示慢性移植物抗宿主病（cGVHD）。从第518天开始进行类固醇治疗，蛋白尿明显改善。异基因造血干细胞移植（allo-HSCT）后NS非常罕见。当不存在伴随的cGVHD时，如本例，allo-HSCT相关的NS很难与特发性NS区分开来。
