High-dose melphalan and autologous hematopoietic stem cell transplant in patient with C3 glomerulonephritis associated with monoclonal gammopathy

Clin Nephrol. 2018 Apr;89(4):291-299. doi: 10.5414/CN109300.

Abstract

There is currently no standard treatment for monoclonal immunoglobulin (MIg)-associated C3 glomerulopathy, and treatment is often dictated by the extent of the monoclonal gammopathy. Although chemotherapy treatment for MIg-associated C3 glomerulopathy may stabilize renal function, the overall renal prognosis of MIg-associated C3 glomerulopathy is still poor with frequent progression to end-stage renal disease. We present a case of a 55-year-old man with IgG-κ gammopathy-associated C3 glomerulonephritis (C3GN) with bone marrow biopsy demonstrating 5 - 10 κ-restricted plasma cells. Following chemotherapy treatment unfortunately, the patient encountered relapsing courses of the disease. The patient subsequently received high-dose melphalan treatment followed by autologous hematopoietic stem cell transplant (ASCT). At 8 months follow-up, the patient remained hematologic response with stable kidney function. Since ASCT can offer durable hematologic remission, ASCT can potentially be a curative treatment option for patients with MIg-associated C3GN. .

Publication types

  • Case Reports

MeSH terms

  • Biopsy, Needle
  • Complement C3 / metabolism*
  • Glomerulonephritis / complications
  • Glomerulonephritis / therapy*
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Kidney Glomerulus / pathology
  • Male
  • Melphalan / administration & dosage*
  • Middle Aged
  • Paraproteinemias / complications
  • Paraproteinemias / therapy*
  • Prognosis
  • Transplantation, Autologous

Substances

  • Complement C3
  • Melphalan