Korean J Hematol.  2006 Sep;41(3):199-203. 10.5045/kjh.2006.41.3.199.

A Case of Acute Lymphoblastic Leukemia in a Patient with Minimal Change Nephrotic Syndrome

• Kim IY
• Moon JY
• Song MK
• Ahn YS
• Kim KY
• Choi YJ
• Shin HJ
• Chung JS
• Cho GJ

• KMID: 2252302
• DOI: http://doi.org/10.5045/kjh.2006.41.3.199

Abstract

We experienced a 22-year old patient with a documented history of minimal change nephrotic syndrome (MCNS), and a diagnosis of acute lymphoblastic leukemia (ALL) was then made for this patient. The patient received standard daily steroid therapy for the treatment of nephrotic syndrome. Cyclosporin A was administered because there was no clinical improvement with steroid therapy. Six years after the diagnosis of nephrotic syndrome, the patient was diagnosed with ALL. After chemotherapy for ALL, the patient was in complete remission and he showed clinical improvement of nephrotic syndrome. The hematological malignancies associated with nephrotic syndrome are mainly lymphoma and chronic lymphocytic leukemia. ALL has rarely been described in combination with nephrotic syndrome. Although the exact mechanism for development of ALL after nephrotic syndrome is unknown, at least two possibilities exist. First, the incidence of leukemia may be increased after immunosuppressive therapy, which may include cyclosporin A. Second, the underlying defect in T-lymphocyte function could account for both nephrotic syndrome and ALL. The possible mechanisms for such a relationship are discussed here along with a review of the relevant literature.

Keyword

Acute lymphoblastic leukemia; Nephrotic syndrome; Cyclosporin A

MeSH Terms

Cyclosporine
Diagnosis
Drug Therapy
Hematologic Neoplasms
Humans
Incidence
Leukemia
Leukemia, Lymphocytic, Chronic, B-Cell
Lymphoma
Nephrosis, Lipoid*
Nephrotic Syndrome
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
T-Lymphocytes
Young Adult
Cyclosporine