Bortezomib maintenance for the treatment of Monoclonal Gammopathy of Renal Significance
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Abstract
Monoclonal gammopathy of renal significance (MGRS) defines renal disease resulting from monoclonal proteins that are secreted from clonal B cells, that does not meet criteria for lymphoma or multiple myeloma. Recognizing MGRS in clinical practice is important because renal outcomes are poor and treatments targeting the underlying clonal disease have been associated with improved renal survival. In this case report, we present a case of a patient with membranoproliferative glomerulonephritis (MPGN) with IgG-kappa deposition who underwent clone directed treatment in a phased approach with induction and maintenance to achieve renal response. This is one of the first cases to report on MGRS treatment that required extended maintenance therapy.
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References
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13. Chauvet, S., V. Fremeaux-Bacchi, F. Petitprez, A. Karras, L. Daniel, S. Burtey, G. Choukroun, Y. Delmas, D. Guerrot, A. Francois, M. Le Quintrec, V. Javaugue, D. Ribes, L. Vrigneaud, B. Arnulf, J.M. Goujon, P. Ronco, G. Touchard, and F. Bridoux. Treatment of B-cell disorder improves renal outcome of patients with monoclonal gammopathy-associated C3 glomerulopathy. Blood, 2017; 129(11): p. 1437-1447. Retrieved from http://www.bloodjournal.org/content/129/11/1437.long?sso-checked=true
14. Kumar, S., S.T. Mahmood, M.Q. Lacy, A. Dispenzieri, S.R. Hayman, F.K. Buadi, D. Dingli, S.V. Rajkumar, M.R. Litzow, and M.A. Gertz. Impact of early relapse after auto-SCT for multiple myeloma. Bone Marrow Transplant, 2008; 42(6): p. 413-20. Retrieved from https://www.nature.com/articles/bmt2008180
2. Leung, N., M.E. Drosou, and S.H. Nasr. Dysproteinemias and Glomerular Disease. Clin J Am Soc Nephrol, 2018; 13(1): p. 128-139. Retrieved from https://cjasn.asnjournals.org/content/13/1/128.long
3. Al-Hussain, T., M.H. Hussein, H. Al Mana, and M. Akhtar. Renal involvement in monoclonal gammopathy. Adv Anat Pathol, 2015; 22(2): p. 121-34. Retrieved from https://journals.lww.com/anatomicpathology/Abstract/2015/03000/Renal_Involvement_in_Monoclonal_Gammopathy.5.aspx
4. Nasr, S.H., A. Satoskar, G.S. Markowitz, A.M. Valeri, G.B. Appel, M.B. Stokes, T. Nadasdy, and V.D. D'Agati. Proliferative glomerulonephritis with monoclonal IgG deposits. J Am Soc Nephrol, 2009; 20(9): p. 2055-64. Retrieved from https://jasn.asnjournals.org/content/20/9/2055.full
5. Fermand, J.P., F. Bridoux, R.A. Kyle, E. Kastritis, B.M. Weiss, M.A. Cook, M.T. Drayson, A. Dispenzieri, and N. Leung. How I treat monoclonal gammopathy of renal significance (MGRS). Blood, 2013; 122(22): p. 3583-90. Retrieved from http://www.bloodjournal.org/content/122/22/3583
6. Palladini, G., A. Dispenzieri, M.A. Gertz, S. Kumar, A. Wechalekar, P.N. Hawkins, S. Schonland, U. Hegenbart, R. Comenzo, E. Kastritis, M.A. Dimopoulos, A. Jaccard, C. Klersy, and G. Merlini. New criteria for response to treatment in immunoglobulin light chain amyloidosis based on free light chain measurement and cardiac biomarkers: impact on survival outcomes. J Clin Oncol, 2012; 30(36): p. 4541-9. Retrieved from http://ascopubs.org/doi/full/10.1200/JCO.2011.37.7614
7. Radhakrishnan, J. and D.C. Cattran. The KDIGO practice guideline on glomerulonephritis: reading between the (guide)lines--application to the individual patient. Kidney Int, 2012; 82(8): p. 840-56. Retrieved from https://www.kidney-international.org/article/S0085-2538(15)55654-8/fulltext
8. Nasr, S.H., G.S. Markowitz, M.B. Stokes, S.V. Seshan, E. Valderrama, G.B. Appel, P. Aucouturier, and V.D. D'Agati. Proliferative glomerulonephritis with monoclonal IgG deposits: a distinct entity mimicking immune-complex glomerulonephritis. Kidney Int, 2004; 65(1): p. 85-96. Retrieved from https://www.kidney-international.org/article/S0085-2538(15)49679-6/fulltext
9. Nasr, S.H., S. Sethi, L.D. Cornell, M.E. Fidler, M. Boelkins, F.C. Fervenza, F.G. Cosio, and V.D. D'Agati. Proliferative glomerulonephritis with monoclonal IgG deposits recurs in the allograft. Clin J Am Soc Nephrol, 2011; 6(1): p. 122-32. Retrieved from https://cjasn.asnjournals.org/content/6/1/122.long
10. Lorenz, E.C., S. Sethi, N. Leung, A. Dispenzieri, F.C. Fervenza, and F.G. Cosio. Recurrent membranoproliferative glomerulonephritis after kidney transplantation. Kidney Int, 2010; 77(8): p. 721-8. Retrieved from https://www.kidney-international.org/article/S0085-2538(15)54346-9/fulltext
11. Steiner, N., G. Göbel, P. Suchecki, W. Prokop, H. Neuwirt, and E. Gunsilius. Monoclonal gammopathy of renal significance (MGRS) increases the risk for progression to multiple myeloma: an observational study of 2935 MGUS patients. Oncotarget, 2018; 9(2): p. 2344-56. Retrieved from http://www.oncotarget.com/index.php?journal=oncotarget&page=article&op=view&path[]=23412&path[]=73752
12. Bhutani, G., S.H. Nasr, S.M. Said, S. Sethi, F.C. Fervenza, W.G. Morice, P.J. Kurtin, F.K. Buadi, D. Dingli, A. Dispenzieri, M.A. Gertz, M.Q. Lacy, P. Kapoor, S. Kumar, R.A. Kyle, S.V. Rajkumar, and N. Leung. Hematologic characteristics of proliferative glomerulonephritides with nonorganized monoclonal immunoglobulin deposits. Mayo Clin Proc, 2015; 90(5): p. 587-96. Retrieved from https://www.mayoclinicproceedings.org/article/S0025-6196(15)00150-0/fulltext
13. Chauvet, S., V. Fremeaux-Bacchi, F. Petitprez, A. Karras, L. Daniel, S. Burtey, G. Choukroun, Y. Delmas, D. Guerrot, A. Francois, M. Le Quintrec, V. Javaugue, D. Ribes, L. Vrigneaud, B. Arnulf, J.M. Goujon, P. Ronco, G. Touchard, and F. Bridoux. Treatment of B-cell disorder improves renal outcome of patients with monoclonal gammopathy-associated C3 glomerulopathy. Blood, 2017; 129(11): p. 1437-1447. Retrieved from http://www.bloodjournal.org/content/129/11/1437.long?sso-checked=true
14. Kumar, S., S.T. Mahmood, M.Q. Lacy, A. Dispenzieri, S.R. Hayman, F.K. Buadi, D. Dingli, S.V. Rajkumar, M.R. Litzow, and M.A. Gertz. Impact of early relapse after auto-SCT for multiple myeloma. Bone Marrow Transplant, 2008; 42(6): p. 413-20. Retrieved from https://www.nature.com/articles/bmt2008180