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Moule P, Gupta D, Agarwal C, Gupta P, Kotwal J, Gupta N. Treatment and Outcome of Light Chain Deposition Disease in the Era of Novel Agents and Transplant. Indian J Hematol Blood Transfus 2024; 40:169-171. [PMID: 38312182 PMCID: PMC10830933 DOI: 10.1007/s12288-023-01681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/10/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
- Priyanka Moule
- Department of Haematology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060 India
| | - Deepika Gupta
- Department of Haematology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060 India
| | - Chetan Agarwal
- Department of Haematology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060 India
| | - Pallav Gupta
- Department of Haematology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060 India
| | - Jyoti Kotwal
- Department of Haematology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060 India
| | - Nitin Gupta
- Department of Haematology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060 India
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Karam S, Haidous M, Dalle IA, Dendooven A, Moukalled N, Van Craenenbroeck A, Bazarbachi A, Sprangers B. Monoclonal gammopathy of renal significance: Multidisciplinary approach to diagnosis and treatment. Crit Rev Oncol Hematol 2023; 183:103926. [PMID: 36736510 DOI: 10.1016/j.critrevonc.2023.103926] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Monoclonal gammopathy of renal significance (MGRS) is a hemato-nephrological term referring to a heterogeneous group of kidney disorders characterized by direct or indirect kidney injury caused by a monoclonal immunoglobulin (MIg) produced by a B cell or plasma cell clone that does not meet current hematologic criteria for therapy. MGRS-associated kidney diseases are diverse and can result in the development of end stage kidney disease (ESKD). The diagnosis is typically made by nephrologists through a kidney biopsy. Many distinct pathologies have been identified and they are classified based on the site or composition of the deposited Mig, or according to histological and ultrastructural findings. Therapy is directed towards the identified underlying clonal population and treatment decisions should be coordinated between hematologists and nephrologists in a multidisciplinary fashion, depend on the type of MGRS, the degree of kidney function impairment and the risk of progression to ESKD.
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Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN, United States
| | - Mohammad Haidous
- Department of Medicine, Saint Vincent Charity Medical Center, Cleveland, OH, United States
| | - Iman Abou Dalle
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amélie Dendooven
- Department of Pathology, University Hospital Ghent, Ghent, Belgium
| | - Nour Moukalled
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amaryllis Van Craenenbroeck
- Department of Microbiology, Immunology and Transplantation, Laboratory of Nephrology, KU Leuven, Leuven, Belgium; Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ben Sprangers
- Biomedical Research Institute, Department of Immunology and Infection, University Hasselt, Diepenbeek, Belgium; Department of Nephrology, Ziekenhuis Oost-Limburg, Genk, Belgium.
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3
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Pianko MJ, Tiutan T, Derkach A, Flynn J, Salvatore SP, Jaffer-Sathick I, Rossi AC, Lahoud O, Hultcrantz M, Shah UA, Maclachlan K, Chung DJ, Shah GL, Landau HJ, Korde N, Mailankody S, Lesokhin A, Tan C, Scordo M, Jaimes EA, Giralt SA, Usmani S, Hassoun H. Assessment of renal outcome following therapy in monoclonal immunoglobulin deposition disease: Emphasizing the need for a consensus approach. Am J Hematol 2023; 98:421-431. [PMID: 36588413 PMCID: PMC10329474 DOI: 10.1002/ajh.26801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023]
Abstract
Monoclonal immunoglobulin deposition disease (MIDD), often associated with plasma cell dyscrasias, predominantly affects the kidneys. In this disease, hematologic response (HR) to treatment can be reliably assessed by International Myeloma Working Group (IMWG) consensus criteria, while uniform criteria for assessing renal response are lacking. We report a retrospective analysis of renal outcomes among 34 patients with MIDD. With most patients treated with bortezomib and autologous stem cell transplantation, 26 of 28 (94%) achieved very good partial HR or better. We demonstrate that both IMWG (based on estimated glomerular filtration rate, eGFR) and amyloid (based on proteinuria) criteria are needed to capture renal response: among 28 evaluable patients, 6 (21%) had isolated proteinuria, while 13 (46%) had isolated decreased eGFR. Using both criteria, which were concordant in patients with both decreased eGFR and proteinuria, 22 of 28 patients (79%) achieved a renal response, including 2 of 7 discontinuing dialyses. All 6 patients (100%) with isolated proteinuria and 7 of 13 (54%) with isolated decreased eGFR achieved renal response, suggesting that isolated proteinuria is an early manifestation of MIDD associated with reversible renal damage. Baseline eGFR predicted renal response (p = .02 by quartile) and survival (p = .02), while HR (CR vs. non-CR) did not, probably because of high HR rate. With a median follow-up of 110 months, the median overall survival was 136 months (95% CI: 79-NR) and median renal survival had not been reached. Prospective studies using uniform renal response criteria are needed to optimize the management of MIDD.
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Affiliation(s)
- Matthew J. Pianko
- Michigan Medicine, University of Michigan Health, Ann Arbor, MI, United States
| | - Timothy Tiutan
- New York-Presbyterian – Weill Cornell Medical Center, New York, NY, United States
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Andriy Derkach
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Jessica Flynn
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Steven P. Salvatore
- New York-Presbyterian – Weill Cornell Medical Center, New York, NY, United States
| | - Insara Jaffer-Sathick
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Adriana C. Rossi
- New York-Presbyterian – Weill Cornell Medical Center, New York, NY, United States
| | - Oscar Lahoud
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Malin Hultcrantz
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Urvi A. Shah
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Kylee Maclachlan
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - David J. Chung
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Gunjan L. Shah
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Heather J. Landau
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Neha Korde
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Sham Mailankody
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Alexander Lesokhin
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Carlyn Tan
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Michael Scordo
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Edgar A. Jaimes
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Sergio A. Giralt
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Saad Usmani
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Hani Hassoun
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
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Pornchai A, Moua T. Dyspnea and cough in a 68-year-old female with light chain deposition disease. Respir Med Case Rep 2023; 43:101839. [PMID: 37021143 PMCID: PMC10068249 DOI: 10.1016/j.rmcr.2023.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/31/2023] [Accepted: 03/17/2023] [Indexed: 03/28/2023] Open
Abstract
Light chain deposition disease (LCDD) is a rare hematologic disorder characterized by non-amyloid monoclonal immunoglobulin light chain deposition in multiple organs. Pulmonary LCDD (PLCDD) is an uncommon manifestation of LCDD usually seen in middle-aged patients presenting with radiologic cystic and nodular findings. We report the case of a 68-year-old female who presented with shortness of breath and atypical chest pain. Chest computerized tomography (CT) scan revealed numerous diffuse but basilar predominant pulmonary cysts and mild bronchiectasis without nodular disease. Given concomitant abnormal renal function and hepatic laboratory indices, she underwent biopsy of both organs confirming the presence of LCDD. Directed chemotherapy was initiated and stabilized renal and hepatic progression, but on follow-up imaging, pulmonary disease appeared worse. While therapeutic options targeting other organ involvement are available, their directed efficacy for progressive lung disease is not well known.
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Affiliation(s)
| | - Teng Moua
- Corresponding author. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Dykes K, Desale S, Javaid B, Miatlovich K, Kessler C. A New Reality for Multiple Myeloma Renal Failure: US Data Report on Kidney Transplant Outcomes. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e314-e320. [PMID: 34872880 DOI: 10.1016/j.clml.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/18/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Describe graft and overall survival outcomes in multiple myeloma (MM) patients who underwent kidney transplant (KT) compared to the general KT population. PATIENTS AND METHODS The Organ Procurement and Transplantation Network/National United Network for Organ Sharing (OPTON/UNOS) database was analyzed from 1988 to 2019 with R 4.00 and the 2013-2017 United States Renal Data System (USRDS) was surveyed for incidence and mortality of MM ESRD. RESULTS USRDS analysis revealed 961 patients diagnosed with ESRD due to MM on average annually, accounting for 0.8% of the ESRD population. Without KT, 44.4% of MM patients died in the first year of renal replacement initiation. OPTON/UNOS analysis identified 218 MM KT patients, compared to 490,089 patients without MM. There was no difference in graft survival between MM KT and the general population (P-value = .13, HR = 1.19 [0.95, 1.49], 95% CI). Median graft survival in MM KT was 2683 days (7.4 years). KT patients with MM had a higher risk for death (P-value = <.0001, HR = 1.83 [1.41, 2.37], 95% CI), and median overall survival was 3076 days (8.4 years). Survival difference was lost when comparing patients ≥50 years (P-value = .42, HR = 1.14 [0.83, 1.56], 95% CI). CONCLUSION Patients with MM renal failure who underwent KT had equivalent graft and age-matched overall survival compared to the general KT population. Therefore select patients with MM renal failure have potential for excellent KT outcomes, should be considered for transplantation when feasible, and should not be excluded from KT based on a history of MM.
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Affiliation(s)
- Kaitlyn Dykes
- MedStar Georgetown University Hospital Internal Medicine, Washington, DC.
| | - Sameer Desale
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Hyattsville, MD
| | - Basit Javaid
- MedStar Georgetown Transplant Institute, Washington, DC
| | - Krystsina Miatlovich
- Institute of Business and Management of Technologies, Belarusian State University, Minsk, Belarus
| | - Craig Kessler
- MedStar Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
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6
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Heybeli C, Bentall AJ, Alexander MP, Amer H, Buadi FK, Dispenzieri A, Dingli D, Gertz MA, Issa N, Kapoor P, Kukla A, Kumar S, Lorenz EC, Rajkumar SV, Schinstock CA, Leung N. Kidney Transplant Outcomes of Patients With Multiple Myeloma. Kidney Int Rep 2022; 7:752-762. [PMID: 35497786 PMCID: PMC9039485 DOI: 10.1016/j.ekir.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/04/2021] [Accepted: 01/03/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Data on kidney transplantation (KTx) outcomes of patients with multiple myeloma (MM) are very limited. Methods We investigated the outcomes of patients with MM who underwent KTx between 1994 and 2019. Results A total of 12 transplants from 11 patients were included. At the time of KTx, 6 were classified as having stringent complete response (CR), 2 as CR, 2 as very good partial response (VGPR), and 2 as partial response (PR). With a median follow-up of 40 (minimum–maximum, 5–92) months after KTx, hematologic progression occurred in 9 transplants (75%). There were 3 grafts (25%) that failed, and 5 patients (45.5%) experienced death with functioning allografts. Graft survival at 1 and 5 years was 82.5% and 66%, respectively. Progression-free survival (PFS) rates of the cohort at 1, 3, and 5 years were 83.3%, 55.6%, and 44.4%, respectively. The estimated median PFS of patients who received bortezomib at any time (pre-KTx and/or post-KTx) was not reached, whereas it was 24 months for those who never received bortezomib (P = 0.281). Overall survival (OS) rates of the cohort at 1, 3, and 5 years were 81.8%, 61.4%, and 61.4%, respectively. OS of patients who received bortezomib at any time was 87.5%, 72.9%, and 72.9%, and that for those who never received bortezomib was 66.7%, 33.3%, and 33.3% (P = 0.136). All deaths occurred owing to hematologic progression or treatment-related complications. Conclusion Kidney transplant outcomes of patients with myeloma who received bortezomib before or after KTx seem to be more favorable. Nevertheless, relapse after KTx in MM is still common. More studies are needed to better determine who benefits from a KTx.
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Rendo M, Franks TJ, Galvin JR, Berglund A, Volk C, Peterson M. Autologous Stem Cell Transplantation in the Treatment of Pulmonary Light Chain Deposition Disease. Chest 2021; 160:e13-e17. [PMID: 34246382 DOI: 10.1016/j.chest.2021.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 10/20/2022] Open
Abstract
Light chain deposition disease is a rare condition that results in the deposition of light chains in organs and their subsequent dysfunction. It is often the consequence of unchecked light chain production by a plasma cell clone. Rarely does it manifest with solely pulmonary involvement, especially in the young otherwise healthy patient. This article highlights the presentation and diagnosis of pulmonary light chain deposition disease in an active duty solider, the discovery of a plasma cell clone responsible for his symptoms, and the therapy targeted at the plasma cell clone-inducing pulmonary disease. This therapy included a novel successful treatment with an autologous stem cell transplantation. To date, it is among the first such documented successful bone marrow transplantations in treatment of isolated pulmonary light chain deposition disease.
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Affiliation(s)
- Matthew Rendo
- Department of Hematology and Oncology, Brooke Army Medical Center, Fort Sam Houston, TX.
| | - Teri J Franks
- The Joint Pathology Center, Defense Health Agency National Capital Region Medical Directorate, Silver Springs, MD
| | - Jeffrey R Galvin
- Department of Defense and Diagnostic Radiology and Nuclear Medicine and Pulmonary/Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Andrew Berglund
- Department of Pulmonary/Critical Care, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Charles Volk
- Pulmonary/Critical Care, Naval Medical Center San Diego, San Diego, CA
| | - Matthew Peterson
- Department of Hematology and Oncology, Brooke Army Medical Center, Fort Sam Houston, TX
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Shimamura Y, Ogawa Y, Takizawa H, Hayashi T, Sakurai Y. Light Chain Deposition Disease Diagnosed Using Computed Tomography-Guided Kidney Biopsy. Cureus 2021; 13:e15102. [PMID: 34159010 PMCID: PMC8212893 DOI: 10.7759/cureus.15102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Light chain deposition disease (LCDD) is characterized by the deposition of monoclonal immunoglobulin light chains in the kidney, which can cause end-stage kidney disease if not treated. While kidney biopsy is required for definitive diagnosis, choosing an appropriate biopsy method may be problematic when examining patients with atrophic kidneys. A 66-year-old Japanese man was referred to our institution with a three-month history of leg edema. Clinical investigations revealed proteinuria levels of 7.5 g/day. CT-guided percutaneous kidney biopsy was selected as the biopsy method because atrophic kidneys were poorly visualized on ultrasonography. Kidney biopsy revealed nodular glomerulosclerosis, exclusive deposition of the κ chain, and powdery electron-dense deposits, all of which were indicative of LCDD. Bence-Jones protein was detected in the urine. The patient also had an abnormal serum-free light chain ratio. Bone marrow biopsy revealed multiple myeloma; therefore, the patient was diagnosed to have LCDD with multiple myeloma. The patient was treated with daratumumab, bortezomib, cyclophosphamide, and dexamethasone. After a one-year follow-up, the patient had hematological and renal responses without any treatment-related adverse effects. Our case demonstrates the effectiveness of daratumumab as a treatment for LCDD with nephrotic-range proteinuria. Additionally, we suggest that CT-guided kidney biopsy should be considered as a diagnostic test in patients with kidney atrophy when making a definitive diagnosis.
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Affiliation(s)
| | - Yayoi Ogawa
- Department of Renal Pathology, Hokkaido Renal Pathology Center, Sapporo, JPN
| | - Hideki Takizawa
- Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, JPN
| | - Toshiaki Hayashi
- Department of Hematology, Teine Keijinkai Medical Center, Sapporo, JPN
| | - Yasuo Sakurai
- Department of Radiology, Teine Keijinkai Medical Center, Sapporo, JPN
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9
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Daratumumab in light chain deposition disease: rapid and profound hematologic response preserves kidney function. Blood Adv 2021; 4:1321-1324. [PMID: 32251496 DOI: 10.1182/bloodadvances.2020001553] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/02/2020] [Indexed: 01/07/2023] Open
Abstract
Key PointsDaratumumab is effective in treated light chain deposition disease. Daratumumab can prevent progression of renal failure in these patients.
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11
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Zhang PL, Herrera GA, Liu B. Monoclonal glomerulopathy with features of cryoglobulinemic glomerulopathy in murine multiple myeloma model. Ultrastruct Pathol 2020; 44:387-394. [PMID: 33135540 DOI: 10.1080/01913123.2020.1841349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In vivo and animal models of monoclonal light chain-associated renal diseases are limited. The Vk*MYC transgenic model with multiple myeloma in 50-70 weeks old mice with renal involvement has been reported before, but detailed renal pathologic changes have not been well documented. This study fully investigated pathologic changes in the kidneys of Vk*MYC transgenic model using light microscopy, immunofluorescence stains for kappa and lambda light chains, and electron microscopy. Compared to the kidneys of wild-type mice, the kidneys of transgenic mice showed either mesangial segmental expansion, some with associated hypercellularity, and/or thrombotic obstruction of glomerular capillaries. The glomeruli revealed stronger lambda staining than kappa light chain staining. Six out of 12 kidneys from transgenic mice showed abundant electron-dense deposits when examined ultrastructurally. The deposits were located in glomerular capillary lumina in three cases. Large luminal and subendothelial deposits were characterized by randomly disposed microtubular structures measuring up to 16 nm in diameter, with overall features most consistent with cryoglobulins. In summary, about 50% of kidneys from the Vk*MYC mice with myeloma had features most consistent with monoclonal cryoglobulinemic glomerulopathy.
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Affiliation(s)
- Ping L Zhang
- Division of Anatomic Pathology, Beaumont Laboratories, Beaumont Health , Royal Oak, MI, USA
| | | | - Bei Liu
- Department of Microbiology and Immunology, Hollings Cancer Center, Medical University of South Carolina , Charleston, SC, USA.,Department of Internal Medicine/Division of Hematology, Ohio State University , Columbus, OH, USA
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12
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Pathophysiology and management of monoclonal gammopathy of renal significance. Blood Adv 2020; 3:2409-2423. [PMID: 31409583 DOI: 10.1182/bloodadvances.2019031914] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022] Open
Abstract
Recent years have witnessed a rapid growth in our understanding of the pathogenic property of monoclonal proteins. It is evident that some of these small monoclonal proteins are capable of inducing end-organ damage as a result of their intrinsic physicochemical properties. Hence, an umbrella term, monoclonal gammopathy of clinical significance (MGCS), has been coined to include myriad conditions attributed to these pathogenic proteins. Because kidneys are the most commonly affected organ (but skin, peripheral nerves, and heart can also be involved), we discuss MGRS exclusively in this review. Mechanisms of renal damage may involve direct or indirect effects. Renal biopsy is mandatory and demonstration of monoclonal immunoglobulin in kidney, along with the corresponding immunoglobulin in serum or urine, is key to establish the diagnosis. Pitfalls exist at each diagnostic step, and a high degree of clinical suspicion is required to diagnose MGRS. Recognition of MGRS by hematologists and nephrologists is important, because timely clone-directed therapy improves renal outcomes. Autologous stem cell transplant may benefit selected patients.
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Batko K, Malyszko J, Jurczyszyn A, Vesole DH, Gertz MA, Leleu X, Suska A, Krzanowski M, Sułowicz W, Malyszko JS, Krzanowska K. The clinical implication of monoclonal gammopathies: monoclonal gammopathy of undetermined significance and of renal significance. Nephrol Dial Transplant 2020; 34:1440-1452. [PMID: 30169860 DOI: 10.1093/ndt/gfy259] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Indexed: 12/23/2022] Open
Abstract
Monoclonal gammopathy of renal significance (MGRS) has introduced a new perspective to several well-known disease entities impacting nephrology, haematology and pathology. Given the constantly changing disease spectrum of these entities, it is clinically imperative to establish diagnostic and treatment pathways supported by evidence-based medicine. MGRS is a disease of the kidney, secondary to plasma cell clonal proliferation or immune dysfunction, requiring therapeutic intervention to eradicate the offending clone. To fully understand the disease(s), it is prerequisite to determine the significance of the findings. The diagnostic work up should be extensive due to the wide heterogeneity of clinical presentation, ultimately necessitating kidney biopsy. Particular patient profiles such as AL amyloidosis, which may be diagnosed through biopsies of other tissues/organs, may be an exception. Treatment decisions should be formulated by multi-disciplinary consensus: nephrologists, haematologists and pathologists. The ultimate goal in managing MGRS is eradication of the offending plasma cell clone which requires targeted chemotherapy and, in eligible cases, haematopoietic stem cell transplantation. We present a review of diagnostic procedures, treatment options and advances in the last few years in the management of MGRS in an effort to acquaint specialists with this new face of several older diseases.
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Affiliation(s)
- Krzysztof Batko
- Departament of Nephrology, Jagiellonian University Medical College, Kraków, Poland
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warszawa, Poland
| | - Artur Jurczyszyn
- Departament of Hematology, Jagiellonian University Medical College, Kraków, Poland
| | - David H Vesole
- Myeloma DIvision, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Xavier Leleu
- Service d`Hematologie CHU, Hopital de la Miletrie, Poitiers, France
| | - Anna Suska
- Departament of Hematology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Krzanowski
- Departament of Nephrology, Jagiellonian University Medical College, Kraków, Poland
| | - Władysław Sułowicz
- Departament of Nephrology, Jagiellonian University Medical College, Kraków, Poland
| | - Jacek S Malyszko
- 1st Department of Nephrology, Medical University, Bialystok, Poland
| | - Katarzyna Krzanowska
- Departament of Nephrology, Jagiellonian University Medical College, Kraków, Poland
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14
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Wang Q, Jiang F, Xu G. The pathogenesis of renal injury and treatment in light chain deposition disease. J Transl Med 2019; 17:387. [PMID: 31767034 PMCID: PMC6878616 DOI: 10.1186/s12967-019-02147-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 11/19/2019] [Indexed: 11/11/2022] Open
Abstract
Light chain deposition disease (LCDD) is a rare clinical disorder. The deposition of light chain immunoglobulins mainly affects the kidneys, which have different characteristics than other tissues. To date, the therapeutic approach for the treatment of LCDD has no evidence-based consensus, and clinical experience of reported cases guides current disease management strategies. The present systematic review investigates and summarizes the pathological mechanisms of renal injury and the subsequent treatments for LCDD.
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Affiliation(s)
- Qi Wang
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Zip Code: 330006, People's Republic of China.,Medical Center of the Graduate School, Nanchang University, Nanchang, China
| | - Fang Jiang
- Department of Nephrology, People's Hospital of Xinyu City, No. 369, Xinxin North Avenue, High-tech District, Xinyu, People's Republic of China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Zip Code: 330006, People's Republic of China.
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Lim WH, Au E, Krishnan A, Wong G. Assessment of kidney transplant suitability for patients with prior cancers: is it time for a rethink? Transpl Int 2019; 32:1223-1240. [PMID: 31385629 PMCID: PMC6900036 DOI: 10.1111/tri.13486] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/16/2019] [Accepted: 07/31/2019] [Indexed: 12/19/2022]
Abstract
Kidney transplant recipients have up to a 100-fold greater risk of incident cancer compared with the age/sex-matched general population, attributed largely to chronic immunosuppression. In patients with a prior history of treated cancers, the type, stage and the potential for cancer recurrence post-transplant of prior cancers are important factors when determining transplant suitability. Consequently, one of the predicaments facing transplant clinicians is to determine whether patients with prior cancers are eligible for transplantation, balancing between the accelerated risk of death on dialysis, the projected survival benefit and quality of life gains with transplantation, and the premature mortality associated with the potential risk of cancer recurrence post-transplant. The guidelines informing transplant eligibility or screening and preventive strategies against cancer recurrence for patients with prior cancers are inconsistent, underpinned by uncertain evidence on the estimates of the incidence of cancer recurrence and the lack of stage-specific outcomes data, particularly among those with multiple myeloma or immune-driven malignancies such as melanomas. With the advent of newer anti-cancer treatment options, it is unclear whether the current guidelines for those with prior cancers remain appropriate. This review will summarize the uncertainties of evidence informing the current recommendations regarding transplant eligibility of patients with prior cancers.
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Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Eric Au
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anoushka Krishnan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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16
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Huang J, Sun C, Su H, Zhang C, Xiong J. Bortezomib-Based Chemotherapy with Autologous Stem Cell Transplantation for Monoclonal Gammopathy of Renal Significance: A Case Report and Literature Review. Kidney Blood Press Res 2019; 44:858-869. [PMID: 31352451 DOI: 10.1159/000501314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The term monoclonal gammopathy of renal significance (MGRS) was introduced in 2012 to emphasize kidney lesions in monoclonal gammopathy patients. Bortezomib-based chemotherapy has become the first-line treatment for MGRS. OBJECTIVES The objective of this study was to investigate whether the strategy of combining chemotherapy with autologous stem cell transplantation (ASCT) could improve prognosis and decrease functional kidney impairment in patients with MGRS. METHODS We reported the case of a 44-year-old Asian patient who was diagnosed with MGRS and received 5 cycles of Velcade® (a trade name for bortezomib), thalidomide, and dexamethasone therapy (VTD therapy), and subsequently underwent ASCT. In addition, we performed a literature review and summarized the latest advances in the characterization, treatment, and prognosis of MGRS. RESULTS The patient was diagnosed with light chain deposition disease by renal biopsy. After 5 cycles of VTD therapy, the patient had a very good partial response characterized by the resolution of M-protein (20.2% before treatment vs. 2.5% after treatment), remission of the level of serum free lambda (FLAM; over 80% decline), and normalization of the serum free light chain (sFLC) ratio (κ to λ). He also had a renal response characterized by a decreased serum creatinine level (1.61 vs.1.34 mg/dL) and less severe proteinuria (6.77 g/24 h vs.1.264 g/24 h) after chemotherapy. Importantly, after ASCT, the patient achieved a complete response (CR) characterized by a negative serum immunofixation electrophoresis (IFE) result and a dramatic decrement in FLAM (over 90%). Furthermore, 6 months after ASCT, the patient still remained in stable condition with a negative IFE result, normal sFLC ratio, and low level of serum creatinine (1.31 mg/dL) and proteinuria (0.339 g/24 h). In our retrospective literature analysis, we found that MGRS patient survival time and renal outcome had been markedly improved by current therapies due to the popularization of bortezomib-based chemotherapy and ASCT. CONCLUSIONS The patient successfully achieved CR after VTD therapy followed by ASCT. However, this treatment is controversial, and a standard therapy recommendation for MGRS has not been established. Bortezomib-based chemotherapy combined with ASCT may have prospects for the treatment of MGRS, but the exact effects of ASCT remain unclear and should be thoroughly investigated.
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Affiliation(s)
- Jing Huang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunyan Sun
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Su
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Xiong
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
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17
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Van den bosch I, Sprangers B, Gertz M. Multiple myeloma and kidney transplantation: the beginning of a new era. Clin Kidney J 2019; 12:213-215. [PMID: 30976398 PMCID: PMC6452187 DOI: 10.1093/ckj/sfz003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Indexed: 11/13/2022] Open
Abstract
The introduction of several novel therapeutic agents has improved the outcome in multiple myeloma (MM) patients including those with chronic kidney disease, and it is predicted that MM will become a curable disease in a substantial subset of MM patients. While in the past-because of inferior posttransplant outcomes-renal transplantation was not offered to MM patients, recent data suggest that renal transplantation is a viable treatment option in patients treated with modern anti-myeloma induction therapy followed by autologous stem cell transplantation achieving durable complete responses. The article of Shah, Ibrahim, Delaney et al. [Risk of relapse of multiple myeloma following kidney transplantation: a case series report. Clin Kidney J 2018 (in this issue)] in the current issue of Clinical Kidney Journal adds to this evidence and highlights the limitations and outstanding questions concerning renal transplantation in MM patients.
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Affiliation(s)
- Ines Van den bosch
- Department of Microbiology and Immunology, Laboratory of Molecular Immunology, Rega Institute, KU Leuven, Leuven, Belgium
- Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Ben Sprangers
- Department of Microbiology and Immunology, Laboratory of Molecular Immunology, Rega Institute, KU Leuven, Leuven, Belgium
- Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Morie Gertz
- Division of Hematology, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
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18
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Sudo M, Wakamatsu T, Ishikawa T, Habuka M, Hosojima M, Yamamoto S, Ito Y, Imai N, Kaneko Y, Shimizu A, Narita I. Successful treatment of gamma 1 heavy chain deposition disease with bortezomib and dexamethasone. HUMAN PATHOLOGY: CASE REPORTS 2019. [DOI: 10.1016/j.ehpc.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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19
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Kimura S, Ohkawara H, Ogawa K, Tanaka M, Sano T, Harada-Shirado K, Takahashi H, Ueda K, Shichishima-Nakamura A, Matsumoto H, Ikeda K, Kazama JJ, Hashimoto Y, Ikezoe T. Lenalidomide as a Beneficial Treatment Option for Renal Impairment Caused by Light Chain Deposition Disease. Intern Med 2018; 57:3651-3657. [PMID: 30101913 PMCID: PMC6355407 DOI: 10.2169/internalmedicine.1018-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Light chain deposition disease (LCDD) is a rare systemic disorder caused by the deposition of light chain immunoglobulins, which often results in renal impairment associated with either nephrotic syndrome or asymptomatic proteinuria. B-cell neoplasms, such as multiple myeloma and lymphoproliferative disorders, are well-known underlying diseases in LCDD. Some chemotherapy regimens have been reported, but both evidence-based treatment and management for LCDD have yet to be established. We herein report three cases of LCDD treated with lenalidomide-based therapy, resulting in hematologic responses accompanied by a significant reduction in proteinuria and improvement in the renal function. We recommend lenalidomide-based therapy for renal impairment caused by LCDD.
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Affiliation(s)
- Satoshi Kimura
- Department of Hematology, Fukushima Medical University, Japan
| | | | - Kazuei Ogawa
- Department of Hematology, Fukushima Medical University, Japan
| | - Mizuko Tanaka
- Department of Diagnostic Pathology, Fukushima Medical University, Japan
| | - Takahiro Sano
- Department of Hematology, Fukushima Medical University, Japan
| | | | | | - Koki Ueda
- Department of Hematology, Fukushima Medical University, Japan
| | | | | | - Kazuhiko Ikeda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Japan
| | | | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University, Japan
| | - Takayuki Ikezoe
- Department of Hematology, Fukushima Medical University, Japan
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20
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21
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Cowan AJ, Johnson CK, Libby EN. Plasma cell diseases and organ transplant: A comprehensive review. Am J Transplant 2018; 18:1046-1058. [PMID: 29524307 DOI: 10.1111/ajt.14731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/28/2018] [Accepted: 03/04/2018] [Indexed: 01/25/2023]
Abstract
Plasma cell diseases are a class of hematologic diseases that are sometimes present as preexisting diagnoses prior to organ transplantation, causative factors leading to a need for organ transplantation, or may occur posttransplant as part of the spectrum of posttransplant lymphoproliferative disorders. Herein, we review the most common plasma cell diseases, both as coexisting with other causes of organ failure, but also as a primary underlying cause for organ failure. In many cases, treatment of the underlying clonal disease may be indicated before proceeding with organ transplant. This review aims to provide current and relevant data regarding the management of these conditions in the organ transplant patient, for transplant providers, and those who take care of these patients.
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Affiliation(s)
- Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Edward N Libby
- Division of Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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22
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Agrawal P, Kumar V, Kumar A, Sachdeva MUS, Malhotra P, Nada R. Monoclonal Gammopathy of Renal Significance Triggered by Viral E Hepatitis. Indian J Nephrol 2018; 29:50-52. [PMID: 30814794 PMCID: PMC6375020 DOI: 10.4103/ijn.ijn_417_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Monoclonal gammopathy of undetermined significance does not have end organ damage, but a proportion of cases manifest with renal injury when it is called monoclonal gammopathy of renal significance (MGRS). Herein, we describe a case of acute hepatitis E infection, which precipitated the development of MGRS. The patient underwent kidney biopsy for elevated creatinine with clinical suspicion of drug-induced interstitial nephritis. On light microscopy, there were periodic acid–Schiff negative-fractured casts in tubules with giant cell reaction around them. The tubular epithelial cells showed intracytoplasmic bile pigment. On direct immunofluorescence, casts showed kappa restriction. A diagnosis of bilirubin proximal tubulopathy and light chain cast nephropathy was made, and possibility of myeloma was suggested. On further evaluation, κ:λ ratio was 27, β2 microglobulin was 8036 ng/ml, and bone marrow examination showed 5% plasma cells. There were no bony lesions, and serum calcium was 8.6 mg/dl. The present case is unique in two aspects. First, the patient developed MGRS triggered by acute hepatitis E in less than a month. Second, the MGRS lesion was manifested in the form of light chain cast nephropathy.
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Affiliation(s)
- P Agrawal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - V Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kumar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M U S Sachdeva
- Department of Hematopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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23
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Cazan GC, Foster K, Lunning MA, Tendulkar K. Detection and Treatment of Monoclonal Gammopathy of Renal Significance With Progression to Light Chain Deposition Disease. J Oncol Pract 2017; 13:707-708. [PMID: 28809601 DOI: 10.1200/jop.2017.023085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Kirk Foster
- University of Nebraska Medical Center, Omaha, NE
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24
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Mohan M, Buros A, Mathur P, Gokden N, Singh M, Susanibar S, Jo Kamimoto J, Hoque S, Radhakrishnan M, Matin A, Davis C, Grazziutti M, Thanendrarajan S, van Rhee F, Zangari M, Davies F, Morgan G, Epstein J, Barlogie B, Schinke C. Clinical characteristics and prognostic factors in multiple myeloma patients with light chain deposition disease. Am J Hematol 2017; 92:739-745. [PMID: 28383130 DOI: 10.1002/ajh.24756] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 12/14/2022]
Abstract
Light chain deposition disease (LCDD) is characterized by monotypic immunoglobulin depositions which will eventually lead to loss of organ function if left untreated. While the kidney is almost always affected, the presence and degree of LCDD in other organs vary. Ten to thirty percent of LCDD patients have underlying Multiple Myeloma (MM), yet outcome and prognostic markers in this particular patient group are still lacking. Here, we analyzed 69 patients with MM and biopsy proven LCDD and report on renal and extra-renal involvement and its impact on prognosis as well as renal response depending on hematologic response. Coexisting light chain diseases such as AL amyloid and cast nephropathy were found in 30% of patients; those with LCDD and concurrent amyloid tended to have shorter survival. Cardiac involvement by LCDD was seen in one-third of our patients and was associated with shorter overall survival; such patients also had a significantly higher risk of treatment-related mortality (TRM) after stem cell transplant (SCT) compared to LCDD patients without cardiac involvement. This study highlights that MM patients with LCDD present with different clinical features compared to previously reported LCDD cohorts. Rapid initiation of treatment is necessary to prevent progressive renal disease and worse outcome. Coexisting light chain diseases and cardiac involvement are more common than previously reported and confer worse clinical outcome, emphasizing the need for careful patient careful patient evaluation and treatment selection.
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Affiliation(s)
- Meera Mohan
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Amy Buros
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Pankaj Mathur
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Neriman Gokden
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Manisha Singh
- Division for Nephrology; Department of Medicine, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Sandra Susanibar
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Jorge Jo Kamimoto
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Shadiqul Hoque
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | | | - Aasiya Matin
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Cynthia Davis
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Monica Grazziutti
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | | | - Frits van Rhee
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Maurizio Zangari
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Faith Davies
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Gareth Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Joshua Epstein
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Bart Barlogie
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Carolina Schinke
- Myeloma Institute, University of Arkansas for Medical Sciences; Little Rock Arkansas
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25
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Rekhtina IG, Mendeleeva LP, Stolyarevich ES, Galtseva IV, Povilaitite PE, Biryukova LS. [Secondary monoclonal gammopathy after bone marrow autotransplantation as a cause of worse renal function in light chain immunoglobulin deposition disease]. TERAPEVT ARKH 2016; 88:80-83. [PMID: 27296267 DOI: 10.17116/terarkh201688680-83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper describes a clinical case of a female woman with nephropathy due to light chain deposition disease caused by secretion of κ Bence-Jones protein. Complete immunochemical remission was achieved after induction therapy using a bortezomib + cyclophosphamide + dexamethasone regimen. Renal function remained unchanged (glomerular filtration rate 16 ml/min), there was a reduction in proteinuria from 5.8 to 2.6 g/day. High-dose melphalan (200 mg/m2) chemotherapy with peripheral blood stem cell autotransplantation was performed as consolidation of remission. A year posttransplantation, there was no secretion of κ light chains; however, monoclonal IgG lambda emerged in a quantity of 3.2 g/l. At the same period, nephrotic syndrome became progressive (daily proteinuria 12 g) and dialysis-dependent renal failure developed. A repeat renal biopsy specimen revealed changes, suggesting that there was a decrease in renal deposits of κ light chains. Simultaneously with this, the obvious negative trend as progressive nephrosclerosis and fixation of IgG and λ light chains in the glomeruli (in the sclerotic areas) cause IgGλ monoclonal protein to be involved in the genesis of further kidney injury. Attention is also paid to different characteristics of capillary wall deposits by density (according to the electron microscopic findings), which may point to their different qualitative composition and possibly different formation duration. Papaprotein Gλ disappeared after a year without therapy, suggesting its reactivity. The findings confirm that worse renal function is caused by the action of paraprotein Gλ due to secondary (after autologous hematopoietic stem cells transplantation) monoclonal gammopathy.
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Affiliation(s)
- I G Rekhtina
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - L P Mendeleeva
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - E S Stolyarevich
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
| | - I V Galtseva
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | | | - L S Biryukova
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
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26
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Sivaraj D, Green MM, Ciftci AM, Zahid MF, Johns AA, Ross M, Gasparetto C. Can We Cure Light Chain Deposition Disease of the Kidneys?-A Review and Case Report of a Patient Treated With a Triple Transplant Approach. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:e95-e100. [PMID: 27101986 DOI: 10.1016/j.clml.2016.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/01/2016] [Accepted: 03/21/2016] [Indexed: 02/06/2023]
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27
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Li XM, Rui HC, Liang DD, Xu F, Liang SS, Zhu XD, Huang XH, Liu ZH, Zeng CH. Clinicopathological characteristics and outcomes of light chain deposition disease: an analysis of 48 patients in a single Chinese center. Ann Hematol 2016; 95:901-9. [DOI: 10.1007/s00277-016-2659-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/28/2016] [Indexed: 10/22/2022]
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28
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Kuppachi S, Holanda D, Thomas CP. Light Chain Deposition Disease After Kidney Transplantation With Long Graft Survival: Case Report. Transplant Proc 2016; 48:255-8. [PMID: 26915878 DOI: 10.1016/j.transproceed.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022]
Abstract
Light Chain Deposition Disease (LCDD) is a monoclonal immunoglobulin deposition disease that commonly affects kidneys among other organs. It leads to end-stage renal disease and has a high disease recurrence rate after kidney transplantation. This has led some authors to advise against transplantation in view of the poor long-term graft and patient outcomes. Recent literature has shown improvement/stabilization of native kidney disease following the use of bortezomib. We present 2 cases of LCDD after transplantation with graft dysfunction. They were both treated with different therapeutic agents to induce remission. Because sustained remission was not achieved they received bortezomib following which they have experienced a prolonged period of stable renal function with no clinically detectable disease. These unique cases highlight the possibility to achieve long-term stable graft function and disease remission after renal transplantation for LCDD.
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Affiliation(s)
- S Kuppachi
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
| | - D Holanda
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - C P Thomas
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Department of Internal Medicine, VA Medical Center, Iowa City, Iowa, USA
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29
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Hiyamuta H, Yamada S, Matsukuma Y, Tsuchimoto A, Nakano T, Taniguchi M, Masutani K, Yoshimoto G, Muta T, Akashi K, Kitazono T, Tsuruya K. Light Chain Deposition Disease in an Older Adult Patient Successfully Treated with Long-term Administration of Bortezomib, Melphalan and Prednisone. Intern Med 2016; 55:1319-25. [PMID: 27181540 DOI: 10.2169/internalmedicine.55.5752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old woman was admitted to our hospital because of fatigue and renal dysfunction and was diagnosed with light chain deposition disease (LCDD) with multiple organ involvement (kidney, thyroid gland, heart and eyes). After chemotherapy with bortezomib, cyclophosphamide and dexamethasone, hepatobiliary enzyme levels increased abruptly. A liver biopsy showed light chain deposition in Disse spaces. After two years of treatment with bortezomib, melphalan and prednisone (VMP) administered at shorter intervals relative to regular cycles, the patient showed a hematological and organ response. This case indicates that a relatively low dose intensity VMP regimen is preferable for elderly patients with LCDD with multiple organ involvement.
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Affiliation(s)
- Hiroto Hiyamuta
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
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30
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Glavey SV, Leung N. Monoclonal gammopathy: The good, the bad and the ugly. Blood Rev 2015; 30:223-31. [PMID: 26732417 DOI: 10.1016/j.blre.2015.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/04/2015] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a condition characterized by the presence of a monoclonal gammopathy (MG) in which the clonal mass has not reached a predefined state in which the condition is considered malignant. It is a precursor to conditions such as multiple myeloma or lymphoma at a rate of ~1%/year. Thus, from a hematologic standpoint, MGUS is a fairly benign condition. However, it is now recognized that organ damage resulting from just the MG without the need MM or lymphoma can occur. One of the most recognized is nephropathy secondary to monoclonal gammopathy of renal significance (MGRS). Other well-recognized conditions include neuropathies, oculopathies and dermopathies. Some conditions such as autoimmune diseases and coagulopathies are less common and recognized. Finally, systemic involvement of multiple organs is well described in several entities. In all of these conditions, the role of the MG is no longer insignificant. Thus, the term MGUS should be avoided when describing these entities.
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Affiliation(s)
- Siobhan V Glavey
- Department of Hematology, National University of Ireland, Galway, Ireland
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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31
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Diagnosis of monoclonal gammopathy of renal significance. Kidney Int 2015; 87:698-711. [PMID: 25607108 DOI: 10.1038/ki.2014.408] [Citation(s) in RCA: 258] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/17/2014] [Accepted: 07/24/2014] [Indexed: 12/17/2022]
Abstract
Monoclonal gammopathy of renal significance (MGRS) regroups all renal disorders caused by a monoclonal immunoglobulin (MIg) secreted by a nonmalignant B-cell clone. By definition, patients with MGRS do not meet the criteria for overt multiple myeloma/B-cell proliferation, and the hematologic disorder is generally consistent with monoclonal gammopathy of undetermined significance (MGUS). However, MGRS is associated with high morbidity due to the severity of renal and sometimes systemic lesions induced by the MIg. Early recognition is crucial, as suppression of MIg secretion by chemotherapy often improves outcomes. The spectrum of renal diseases in MGRS is wide, including old entities such as AL amyloidosis and newly described lesions, particularly proliferative glomerulonephritis with monoclonal Ig deposits and C3 glomerulopathy with monoclonal gammopathy. Kidney biopsy is indicated in most cases to determine the exact lesion associated with MGRS and evaluate its severity. Diagnosis requires integration of morphologic alterations by light microscopy, immunofluorescence (IF), electron microscopy, and in some cases by IF staining for Ig isotypes, immunoelectron microscopy, and proteomic analysis. Complete hematologic workup with serum and urine protein electrophoresis, immunofixation, and serum-free light-chain assay is required. This review addresses the pathologic and clinical features of MGRS lesions, indications of renal biopsy, and a proposed algorithm for the hematologic workup.
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Rekhtina IG, Mendeleeva LP, Biryukova LS. Dialysis-dependent renal failure in patients with multiple myeloma: Reversibility factors. TERAPEVT ARKH 2015; 87:72-76. [DOI: 10.17116/terarkh201587772-76] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wada Y, Iyoda M, Saito T, Arai-Nunota N, Iseri K, Tomita E, Ikeda M, Yamaguchi Y, Shibata T. Light-Chain Deposition Disease Successfully Treated with Bortezomib in an Elderly Patient: A Case Report and Review of the Literature. Intern Med 2015; 54:2893-8. [PMID: 26568005 DOI: 10.2169/internalmedicine.54.4994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of an elderly patient with light-chain deposition disease (LCDD) successfully treated with bortezomib. An 83-year-old woman was admitted because of nephrotic syndrome. She was diagnosed to have monoclonal gammopathy of undetermined significance (IgG-κ type) and LCDD, on the basis of serum and urinary immunoelectrophoresis and renal biopsy. She responded to a modified regimen of bortezomib-based chemotherapy with disappearance of proteinuria without any adverse effects. According to a literature review of 16 cases, including the present case, bortezomib-based chemotherapy appears to be a convincing strategy for the treatment of LCDD even in elderly patients.
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Affiliation(s)
- Yukihiro Wada
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Japan
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Hematologic Response and Stabilization of Renal Function in a Patient With Light Chain Deposition Disease After Lenalidomide Treatment: A Novel Therapeutic Approach? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:e179-81. [DOI: 10.1016/j.clml.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/11/2014] [Accepted: 06/04/2014] [Indexed: 11/22/2022]
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Sicard A, Karras A, Goujon JM, Sirac C, Bender S, Labatut D, Callard P, Sarkozy C, Essig M, Vanhille P, Provot F, Nony A, Nochy D, Ronco P, Bridoux F, Touchard G. Light chain deposition disease without glomerular proteinuria: a diagnostic challenge for the nephrologist. Nephrol Dial Transplant 2014; 29:1894-902. [DOI: 10.1093/ndt/gfu045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Leung N, Nasr SH. Myeloma-related kidney disease. Adv Chronic Kidney Dis 2014; 21:36-47. [PMID: 24359985 DOI: 10.1053/j.ackd.2013.08.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/28/2013] [Accepted: 08/30/2013] [Indexed: 12/13/2022]
Abstract
Multiple myeloma is a malignant plasma cell disorder characterized by the overproduction of monoclonal proteins. The kidney is 1 of the major target organs of multiple myeloma. Most often, this is the result of the monoclonal proteins, which can injure the kidney via several mechanisms. In some cases, direct invasion by myeloma cells and/or bone marrow cells can also result in kidney injury. A kidney biopsy can help distinguish the various myeloma-related kidney diseases and aid in the treatment plan.
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Abstract
Recently, the term monoclonal gammopathy of renal significance (MGRS) was introduced to distinguish monoclonal gammopathies that result in the development of kidney disease from those that are benign. By definition, patients with MGRS have B-cell clones that do not meet the definition of multiple myeloma or lymphoma. Nevertheless, these clones produce monoclonal proteins that are capable of injuring the kidney resulting in permanent damage. Except for immunoglobulin light chain amyloidosis with heart involvement in which death can be rapid, treatment of MGRS is often indicated more to preserve kidney function and prevent recurrence after kidney transplantation rather than the prolongation of life. Clinical trials are rare for MGRS-related kidney diseases, except in immunoglobulin light chain amyloidosis. Treatment recommendations are therefore based on the clinical data obtained from treatment of the clonal disorder in its malignant state. The establishment of these treatment recommendations is important until data can be obtained by clinical trials of MGRS-related kidney diseases.
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Ardalan MR. Light chain deposition disease; there are reasons for confusion. J Renal Inj Prev 2013; 2:127-8. [PMID: 25340150 PMCID: PMC4206026 DOI: 10.12861/jrip.2013.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/29/2013] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mohammad-Reza Ardalan
- Chronic Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Monoclonal gammopathy of renal significance: when MGUS is no longer undetermined or insignificant. Blood 2012; 120:4292-5. [PMID: 23047823 DOI: 10.1182/blood-2012-07-445304] [Citation(s) in RCA: 332] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma is the most frequent monoclonal gammopathy to involve the kidney; however, a growing number of kidney diseases associated with other monoclonal gammopathies are being recognized. Although many histopathologic patterns exist, they are all distinguished by the monoclonal immunoglobulin (or component) deposits. The hematologic disorder in these patients is more consistent with monoclonal gammopathy of undetermined significance (MGUS) than with multiple myeloma. Unfortunately, due to the limitations of the current diagnostic schema, they are frequently diagnosed as MGUS. Because treatment is not recommended for MGUS, appropriate therapy is commonly withheld. In addition to end-stage renal disease, the persistence of the monoclonal gammopathy is associated with high rates of recurrence after kidney transplantation. Preservation and restoration of kidney function are possible with successful treatment targeting the responsible clone. Achievement of hematologic complete response has been shown to prevent recurrence after kidney transplantation. There is a need for a term that properly conveys the pathologic nature of these diseases. We think the term monoclonal gammopathy of renal significance is most helpful to indicate a causal relationship between the monoclonal gammopathy and the renal damage and because the significance of the monoclonal gammopathy is no longer undetermined.
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Bansal T, Garg A, Snowden JA, McKane W. Defining the Role of Renal Transplantation in the Modern Management of Multiple Myeloma and Other Plasma Cell Dyscrasias. Nephron Clin Pract 2012; 120:c228-35. [DOI: 10.1159/000341760] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Leung N, Gertz M, Kyle RA, Fervenza FC, Irazabal MV, Eirin A, Kumar S, Cha SS, Rajkumar SV, Lacy MQ, Zeldenrust SR, Buadi FK, Hayman SR, Nasr SH, Sethi S, Ramirez-Alvarado M, Witzig TE, Herrmann SM, Dispenzieri A. Urinary albumin excretion patterns of patients with cast nephropathy and other monoclonal gammopathy-related kidney diseases. Clin J Am Soc Nephrol 2012; 7:1964-8. [PMID: 23024162 DOI: 10.2215/cjn.11161111] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Multiple myeloma is responsible for a wide variety of renal pathologies. Urinary protein and monoclonal spike cannot be used to diagnose cast nephropathy (CN). Because albuminuria is a hallmark of glomerular disease, this study evaluated the percentage of urinary albumin excretion (%UAE) as a tool to differentiate CN from Ig light chain amyloidosis (AL), light chain deposition disease (LCDD), and acute tubular necrosis (ATN). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients were selected from the Renal Biopsy Database and the Dysproteinemia Database. Participants were excluded if laboratory data were missing within 1 week of the renal biopsy. The %UAE was obtained from urine protein electrophoresis. RESULTS From 1992 to 2011, 260 patients were biopsied (177 with AL, 28 with LCDD, 43 with CN, and 12 with ATN). The %UAE for CN patients was significantly lower (7%) than for ATN (25%), LCDD (55%), and AL (70%) patients (P<0.001). Significant differences were also found in serum creatinine, serum albumin, free light chain ratio, total urine protein, and urine monoclonal spike; only the %UAE remained independently associated with CN in a logistic regression model (P<0.001). The area under the curve for the receiver operator characteristic curve for %UAE was 0.99. At <25%, the %UAE had a sensitivity of 0.98, specificity of 0.94, positive predictive value of 0.75, and negative predictive value of 0.99. CONCLUSIONS This study showed that %UAE was significantly less in CN than the other three renal lesions and %UAE may thus be helpful in diagnosis of CN.
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Affiliation(s)
- Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, Minnesota 55901, USA.
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Tovar N, Cibeira MT, Rosiñol L, Solé M, Larrea CF, Escoda L, Rovira M, Bladé J. Bortezomib/dexamethasone followed by autologous stem cell transplantation as front line treatment for light-chain deposition disease. Eur J Haematol 2012; 89:340-4. [DOI: 10.1111/j.1600-0609.2012.01821.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2012] [Indexed: 11/30/2022]
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Canaud G, Audard V, Kofman T, Lang P, Legendre C, Grimbert P. Recurrence from primary and secondary glomerulopathy after renal transplant. Transpl Int 2012; 25:812-24. [DOI: 10.1111/j.1432-2277.2012.01483.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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JIMENEZ-ZEPEDA VH. Light chain deposition disease: novel biological insights and treatment advances. Int J Lab Hematol 2012; 34:347-55. [DOI: 10.1111/j.1751-553x.2012.01419.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim HJ, Park E, Lee TJ, Do JH, Cha YJ, Lee SJ. A case of isolated light chain deposition disease in the duodenum. J Korean Med Sci 2012; 27:207-10. [PMID: 22323870 PMCID: PMC3271296 DOI: 10.3346/jkms.2012.27.2.207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 11/04/2011] [Indexed: 11/25/2022] Open
Abstract
Light chain deposition disease (LCDD) is a rare disorder associated with a clonal proliferation of plasma cells, which synthesize abnormal monoclonal immunoglobulin light chains. LCDD is characterized by systemic deposition of light chains in various organs, with the kidneys being most commonly affected. There have been few reports of isolated LCDD. We report a rare case of LCDD limited to a duodenal polyp. A 63-yr-old man visited our hospital for health screening without symptoms in 2009. On gastrofiberscopy, a duodenal polyp was observed. The biopsy showed diffuse infiltration by atypical plasma cells, which were positive for kappa-type light chains by immunohistochemistry. While the patient refused further management, we could find no evidence of recurrence until 2 yr after the initial diagnosis. It has been reported that isolated LCDD has relatively good prognosis compared to systemic LCDD. However, treatment for this disease has not been established yet.
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Affiliation(s)
- Hee-Jun Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eunkyung Park
- Division of Hemato-Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Jin Lee
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Hyuk Do
- Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Joo Cha
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang Jae Lee
- Division of Hemato-Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Brioli A, Zamagni E, Pasquali S, Tosi P, Tacchetti P, Perrone G, Pantani L, Petrucci A, Zannetti BA, Baccarani M, Cavo M. Long-term follow-up after autologous stem cell transplantation for light- and heavy-chain deposition disease. Bone Marrow Transplant 2012; 47:1248-9. [DOI: 10.1038/bmt.2011.252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Nasr SH, Valeri AM, Cornell LD, Fidler ME, Sethi S, D'Agati VD, Leung N. Renal monoclonal immunoglobulin deposition disease: a report of 64 patients from a single institution. Clin J Am Soc Nephrol 2011; 7:231-9. [PMID: 22156754 DOI: 10.2215/cjn.08640811] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES To better define the clinical-pathologic spectrum and prognosis of monoclonal immunoglobulin deposition disease (MIDD), this study reports the largest series. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Characteristics of 64 MIDD patients who were seen at Mayo Clinic are provided. RESULTS Of 64 patients with MIDD, 51 had light chain deposition disease, 7 had heavy chain deposition disease, and 6 had light and heavy chain deposition disease. The mean age at diagnosis was 56 years, and 23 patients (36%) were ≤50 years of age. Clinical evidence of dysproteinemia was present in 62 patients (97%), including multiple myeloma in 38 (59%). M-spike was detected on serum protein electrophoresis in 47 (73%). Serum free light chain ratio was abnormal in all 51 patients tested. Presentation included renal insufficiency, proteinuria, hematuria, and hypertension. Nodular mesangial sclerosis was seen in 39 patients (61%). During a median of 25 months of follow-up (range, 1-140) in 56 patients, 32 (57%) had stable/improved renal function, 2 (4%) had worsening renal function, and 22 (39%) progressed to ESRD. The mean renal and patient survivals were 64 and 90 months, respectively. The disease recurred in three of four patients who received a kidney transplant. CONCLUSIONS Patients with MIDD generally present at a younger age than those with light chain amyloidosis or light chain cast nephropathy. Serum free light chain ratio is abnormal in all MIDD patients, whereas only three-quarters have abnormal serum protein electrophoresis. The prognosis for MIDD is improving compared with historical controls, likely reflecting earlier detection and improved therapies.
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Affiliation(s)
- Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Hilton 10-20, Rochester, MN 55905, USA.
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González-López TJ, Vázquez L, Flores T, San Miguel JF, García-Sanz R. Long-term reversibility of renal dysfunction associated to light chain deposition disease with bortezomib and dexamethasone and high dose therapy and autologous stem cell transplantation. Clin Pract 2011; 1:e95. [PMID: 24765395 PMCID: PMC3981425 DOI: 10.4081/cp.2011.e95] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/11/2011] [Indexed: 12/30/2022] Open
Abstract
A 63-year-old woman presented with progressive renal insufficiency, until a glomerular filtration rate (GFR) of 12 mL/min. A renal biopsy demonstrated glomerular deposition of immunoglobulin κlight chain. The presence of a small population of monoclonal plasmacytes producing an only light κmonoclonal component was demonstrated and Bortezomib and Dexamethasone (BD) was provided as initial therapy. After seven courses of therapy, renal function improved without dialysis requirements up to a GFR 31 mL/min. Under hematological complete response (HCR) the patient underwent high dose of melphalan (HDM) and autologous peripheral blood stem cell transplant. Fifty-four months later the patient remains in HCR and the GFR has progressively improved up to 48 mL/min. This report describes a notably renal function improvement in a patient with Light Chain Deposition Disease after therapy with BD followed by HDM, which can support this treatment as a future option for these patients.
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Affiliation(s)
| | | | - Teresa Flores
- Pathology Service, University Hospital of Salamanca, Salamanca, Spain
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High-dose melphalan followed by auto-SCT has favorable safety and efficacy in selected patients with light chain deposition disease and light and heavy chain deposition disease. Bone Marrow Transplant 2011; 47:453-5. [DOI: 10.1038/bmt.2011.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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