Risk of relapse of multiple myeloma following kidney transplantation

TY - JOUR

T1 - Risk of relapse of multiple myeloma following kidney transplantation

AU - Shah, Sapna

AU - Ibrahim, Maria

AU - Delaney, Michael

AU - Schey, Steve

AU - Bygrave, Ceri

AU - Streetly, Matthew

AU - Benjamin, Reuben

PY - 2019/4

Y1 - 2019/4

N2 - Background. Autologous stem cell transplantation (ASCT) and novel therapies have improved the prognosis for patients with multiple myeloma (MM). For those who undergo ASCT while on dialysis, a similar survival compared with the overall MM population has been reported. Therefore, for patients achieving remission following ASCT, kidney transplantation is an attractive option, offering an improved quality of life and significant economic advantage. Method. This case series investigates the outcome of five patients who underwent an ASCT for MM with subsequent kidney transplantation between 2006 and 2012. Results. Four patients presented with end-stage renal disease (ESRD) and one progressed to ESRD shortly after diagnosis. Induction chemotherapy regimens with novel agents including thalidomide and bortezomib were utilized. Following attainment of very good partial remission or complete remission, high-dose melphalan ASCTs were performed after a median of 10months. Kidney transplantation (living donor n=3, deceased donor n=2) with tacrolimus-based immunosuppression regimens was completed at a median of 27months after ASCT. Patients 1 and 3 experienced relapse of myeloma at 6 and 16 months after kidney transplantation. Patients 2, 4 and 5 remain alive at 55months (median) after kidney transplantation with no evidence of relapse. Conclusion. Forty percent of our cohort experienced a relapse in MM within 2 years of kidney transplantation. Deathcensored graft survival and patient survival were 80% at 4 years. Our study adds to the growing literature supporting kidney transplantation following successful ASCT for MM and is useful when counselling patients regarding renal and haematological outcomes.

AB - Background. Autologous stem cell transplantation (ASCT) and novel therapies have improved the prognosis for patients with multiple myeloma (MM). For those who undergo ASCT while on dialysis, a similar survival compared with the overall MM population has been reported. Therefore, for patients achieving remission following ASCT, kidney transplantation is an attractive option, offering an improved quality of life and significant economic advantage. Method. This case series investigates the outcome of five patients who underwent an ASCT for MM with subsequent kidney transplantation between 2006 and 2012. Results. Four patients presented with end-stage renal disease (ESRD) and one progressed to ESRD shortly after diagnosis. Induction chemotherapy regimens with novel agents including thalidomide and bortezomib were utilized. Following attainment of very good partial remission or complete remission, high-dose melphalan ASCTs were performed after a median of 10months. Kidney transplantation (living donor n=3, deceased donor n=2) with tacrolimus-based immunosuppression regimens was completed at a median of 27months after ASCT. Patients 1 and 3 experienced relapse of myeloma at 6 and 16 months after kidney transplantation. Patients 2, 4 and 5 remain alive at 55months (median) after kidney transplantation with no evidence of relapse. Conclusion. Forty percent of our cohort experienced a relapse in MM within 2 years of kidney transplantation. Deathcensored graft survival and patient survival were 80% at 4 years. Our study adds to the growing literature supporting kidney transplantation following successful ASCT for MM and is useful when counselling patients regarding renal and haematological outcomes.

KW - Autologous stem cell transplantation

KW - Kidney transplantation

KW - Multiple myeloma

KW - Outcome

UR - http://www.scopus.com/inward/record.url?scp=85068548719&partnerID=8YFLogxK

U2 - 10.1093/ckj/sfy137

DO - 10.1093/ckj/sfy137

M3 - Article

AN - SCOPUS:85068548719

SN - 2048-8505

VL - 12

SP - 216

EP - 223

JO - Clinical Kidney Journal

JF - Clinical Kidney Journal

IS - 2

M1 - sfy137

ER -