Paraneoplastic Minimal Change Disease Signaling Post-Transplant AML Relapse: Two Cases and a Literature Review

Area of Science:

• Nephrology
• Hematology
• Oncology

Background:

• Minimal change disease (MCD) and membranous nephropathy (MN) are common causes of nephrotic syndrome post-hematopoietic stem cell transplantation (HSCT).
• Graft-versus-host disease (GVHD) is the typical cause of these renal complications.
• Paraneoplastic MCD is known in lymphoid malignancies but rare in myeloid neoplasms.

Purpose of the Study:

• To report rare cases of biopsy-confirmed MCD as the initial presentation of acute myeloid leukemia (AML) relapse post-allogeneic HSCT.
• To highlight the significance of MCD in signaling potential leukemia recurrence in HSCT patients.

Main Methods:

• Case report of two patients with relapsed/refractory AML undergoing allogeneic HSCT.
• Analysis of clinical presentation, renal biopsy findings (confirming MCD), treatment response, and outcomes.
• Evaluation of the role of leukemia-directed therapy versus immunosuppression for renal recovery.

Main Results:

• Both patients presented with nephrotic-range proteinuria and acute kidney injury post-HSCT without GVHD.
• Renal biopsies confirmed MCD.
• Corticosteroid therapy was ineffective; renal function improved only after initiating AML-directed therapy.
• One patient achieved dialysis independence.

Conclusions:

• MCD can be a rare paraneoplastic manifestation of AML relapse post-HSCT.
• Nephrotic syndrome due to MCD may indicate leukemia recurrence, especially in steroid-refractory cases or those without GVHD.
• Controlling the underlying AML is crucial for renal recovery in such scenarios, rather than increasing immunosuppression.