Chronic Myelomonocytic Leukemia Patients With Lysozyme Nephropathy and Renal Infiltration Display Markers of Severe Disease
Year: 2023
Type: article
Study design: Observational Study
Abstract: Introduction Chronic myelomonocytic leukemia (CMML) is a hematologic disorder that is an overlap syndrome between myelodysplastic syndromes, and myeloproliferative neoplasms, and can be associated with autoimmune and inflammatory diseases. This study aimed to describe kidney involvement in CMML patients, their treatments, and outcomes. Methods We conducted a French and American multicenter retrospective study in fifteen centers, identifying CMML patients with acute kidney injury (AKI), chronic kidney disease (CKD), and urine abnormalities. Results Sixteen patients (males, n=14, median age 76.5 [71.9-83]) developed a kidney disease 6 months [1.6-25.6] after the diagnosis of CMML. At time of kidney disease diagnosis, median urinary protein to creatinine ratio was 2 g/g [1.25-3.4], and median serum creatinine was 2.26 mg/dL [1.46-2.68]. Fourteen patients (87.5%) underwent a kidney biopsy and the two main pathological findings were lysozyme nephropathy (56%) and renal infiltration by the CMML (37.5%). Ten patients received a new treatment following the CMML-associated kidney injury. Among patients with monitored kidney function, and after a median follow-up of 15 months [9.9-34.9], 4 patients had CKD stage 3, 4 CKD stage 4, 1 an end-stage kidney disease. In our patient series, two patients evolved to an acute myeloid leukemia (AML), and 5 died. Compared with 116 CMML controls, patients who had a kidney involvement had a higher monocytes count (p<0.001), had more CMML-1 (p=0.005), were more susceptible to develop an AML (p=0.02), and were more eligible to receive a specific hematologic treatment, with hydroxyurea, or hypomethylating agents (p<0.001), but no survival difference was seen between the two groups (p=0.6978). Conclusion In this cohort of CMML patients with a kidney injury, the two most frequent renal complications were lysozyme-induced nephropathy, and renal infiltration by the CMML. Kidney involvement should be closely monitored in patients with CMML.
Source: Kidney International Reports
Authors: Marie-Camille Lafargue, Mickaël Bobot, Helmut G. Rennke, Marie Essig, Martin Carre, Lucile Mercadal, Jonathan Farhi, Hamza Sakhi, Thibault Comont, Léonard Golbin, Pierre Isnard, Jonathan Chemouny, Nathalie Cambier, Kamel Laribi, Umut Selamet, Leonardo V. Riella, Olivier Fain, Lionel Adès, Pierre Fenaux, Camille Cohen, Arsène Mekinian, Marie-Camille Lafargue, Mickaël Bobot, Thibault Comont, Nathalie Cambier, Kamel Laribi, Olivier Fain, Lionel Adès, Pierre Fenaux, Arsène Mekinian, Thibault Comont, Nathalie Cambier, Kamel Laribi, Olivier Fain, Lionel Adès, Pierre Fenaux, Arsène Mekinian, Thibault Comont, Olivier Fain, Lionel Adès, Pierre Fenaux, Arsène Mekinian
Institutions: Brigham and Women's Hospital, Harvard University, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Hôpital Tenon, Université Paris-Saclay, Assistance Publique Hôpitaux de Marseille, Hôpital de la Conception, Hôpital Ambroise-Paré, Centre Hospitalier Universitaire de Grenoble, Pitié-Salpêtrière Hospital, Centre Hospitalier Universitaire d'Angers, Hôpital Necker-Enfants Malades, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Université Toulouse III - Paul Sabatier, Centre Hospitalier Universitaire de Toulouse, Institut universitaire du cancer de Toulouse Oncopole, Centre Hospitalier de Valenciennes, Massachusetts General Hospital, Inserm, Centre Hospitalier du Mans, Hôpital Saint-Antoine, Hôpital Saint-Louis, Université Paris Diderot, Laboratoire d'hématologie
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,625
OpenAlex ID: W4386503826