Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
Department of Hematology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Ann Hematol. 2024 Oct;103(10):4261-4270. doi: 10.1007/s00277-024-05875-w. Epub 2024 Jul 11.
Membranous nephropathy (MN) is a rare complication that can occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). MN patients may develop nephrotic syndrome or even kidney failure, which greatly affects their quality of life and prognosis. However, current knowledge regarding MN after allo-HSCT is limited. Thus, a multicenter nested case‒control study was conducted. Patients who had been diagnosed with MN after allo-HSCT were retrospectively identified at 8 HSCT centers. A total of 51 patients with MN after allo-HSCT were included. The median age of MN patients after allo-HSCT was 38 years, and the median duration from HSCT to MN was 18 months. The use of HLA-matched donors (P = 0.0102) and peripheral blood as the graft source (P = 0.0060) were identified as independent predisposing risk factors for the onset of MN after allo-HSCT. Compared to those in the control group, the incidence of extensive chronic graft-versus-host disease was greater in the MN patients (P = 0.0002). A total of 31 patients developed nephrotic syndrome. Patients receiving combination treatments of corticosteroids and immunosuppressants appeared to have better outcomes. In conclusion, MN is a rare but occasionally severe complication following HSCT and may require active treatment.
膜性肾病（MN）是一种罕见的并发症，可发生于异基因造血干细胞移植（allo-HSCT）之后。MN 患者可能会出现肾病综合征甚至肾衰竭，这极大地影响了他们的生活质量和预后。然而，目前对于 allo-HSCT 后 MN 的认识有限。因此，进行了一项多中心巢式病例对照研究。在 8 个 HSCT 中心，回顾性地确定了 allo-HSCT 后被诊断为 MN 的患者。共纳入了 51 例 allo-HSCT 后 MN 患者。MN 患者的中位年龄为 38 岁，从 HSCT 到 MN 的中位时间为 18 个月。HLA 匹配供体的使用（P=0.0102）和外周血作为移植物来源（P=0.0060）被确定为 allo-HSCT 后 MN 发病的独立易感危险因素。与对照组相比，MN 患者广泛慢性移植物抗宿主病的发生率更高（P=0.0002）。共有 31 例患者出现肾病综合征。接受皮质类固醇和免疫抑制剂联合治疗的患者似乎有更好的结局。总之，MN 是 HSCT 后一种罕见但偶尔严重的并发症，可能需要积极治疗。
