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Repeated course of rituximab for treatment of nephrotic syndrome in patients with chronic GVHD

Bone Marrow Transplantation volume 45, pages 1758–1759 (2010)Cite this article

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Nephrotic syndrome is a rare complication of allo-SCTSCT and is often associated with chronic GVHD. Its incidence may increase with the increase in age of transplant recipients, donor lymphocyte infusion and the increase in use of blood stem cell grafts.1, 2, 3 In a report published in 2006, nine patients with chronic GVHD-associated nephrotic syndrome were studied.4 Two out of these nine patients received rituximab therapy with an excellent response. We now report on repeated courses of rituximab in patients with nephrotic syndrome associated with chronic GVHD.

We have previously described the efficacy of rituximab in the treatment of chronic GVHD,6 which was later confirmed by other investigators.7, 8 There are increasing reports of nephrotic syndrome-associated chronic GVHD in the recent years. Most of these cases were associated with chronic GVHD and some of these patients were successfully treated with rituximab.6 We reported on two patients who developed nephrotic syndrome associated with chronic GVHD who were treated with repeated courses of rituximab. One of our patients in the initial report was later treated with two additional cycles (case 2). Both patients tolerated repeated cycles of therapy with a reduction in urinary protein excretion accompanied by improvement in other-organ involvement by chronic GVHD. Recurrence of proteinuria and response to re-treatment suggest a possibility of maintenance treatment with rituximab, as many of the soft-tissue and skin manifestations can be subtle and slowly progressive that they may eventually cause permanent organ damage. Skin and soft-tissue involvement by chronic GVHD in case 1 resolved almost completely and there was modest improvement in case 2. Tolerance to repeated courses of rituximab suggests that maintenance therapy may be possible and should be explored in patients who respond to rituximab therapy, a strategy that has been successfully used in patients with follicular lymphoma.9

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  1. Blood and Marrow Stem Cell Transplantation Program, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA

    S Mellon-Reppen, V Ratanatharathorn, S Cronin & J P Uberti

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  1. S Mellon-Reppen
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  2. V Ratanatharathorn
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  3. S Cronin
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  4. J P Uberti
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Correspondence to V Ratanatharathorn.

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Mellon-Reppen, S., Ratanatharathorn, V., Cronin, S. et al. Repeated course of rituximab for treatment of nephrotic syndrome in patients with chronic GVHD. Bone Marrow Transplant 45, 1758–1759 (2010). https://doi.org/10.1038/bmt.2010.58

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