Autologous Hematopoietic Cell Transplantation for Dialysis-Dependent Myeloma: More Efficient, Less Toxic

Amit, Odelia; Ram, Ron

doi:10.1159/000486890

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…In patients with MM having renal dysfunction/failure, recovery of renal function depends on: the elimination of causes of renal dysfunction/failure, and timely induction therapy using novel agents such as bortezomib in addition to corticosteroids followed by autologous HSCT once the disease is under control [37, 70,71,73,76]. In patients with MM having dialysisdependent renal failure, HD chemotherapy and autologous HSCT have traditionally been contraindicated due to the following reasons: lower survival rates, higher short-term mortality, greater susceptibility to infectious complications, longer duration of hospitalization, greatly compromised quality of life, as well as predilection for the following complications: mucositis, cardiac arrhythmias, bleeding, and encephalopathy [34,37,72,74,78,79].…”

Section: Autologous Hsct In Patients With MM Having Renal Failurementioning

confidence: 99%

“…In patients with MM having ESRD receiving hemodialysis, careful evaluation prior to HSCT with the involvement of a multidisciplinary team should be made and dose adjustment for all drugs that adversely affect renal function should be taken into consideration. In patients with MM having ESRD on hemodialysis, it is recommended to perform hemodialysis before and 24 hours after the administration of HD melphalan [78]. Additionally, in patients with MM having ESRD, combined HSCT and renal transplantation can be performed either simultaneously or sequentially after controlling MM by appropriate chemotherapy [37, 71,85,86].…”

Section: Autologous Hsct In Patients With MM Having Renal Failurementioning

confidence: 99%

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An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

Al-Anazi¹,

Alshaibani²,

Kalogianidis³

2023

Recent Updates on Multiple Myeloma

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Over the past two decades, treatment of multiple myeloma (MM) has advanced dramatically. However, despite the introduction of several lines of novel therapeutics, autologous hematopoietic stem cell transplantation (HSCT) followed by maintenance therapy is the current standard of care in transplant eligible patients. Autologous HSCT can be performed with or without cryopreservation with equivalent short-term and long-term outcomes. In patients with MM, performance of autologous HSCT at outpatient setting is safe, feasible and has a number of advantages such as saving hospital beds and reducing treatment costs. Autologous HSCT can be safely performed in patients with MM having renal dysfunction or failure although particular attention should be made to the timing of administering medications and stem cells with respect to hemodialysis and dose reduction of specific medications according to creatinine clearance. Tandem autologous HSCT is of value in younger patients with adverse cytogenetics and extramedullary disease. Allogeneic HSCT is the only potentially curative therapeutic modality in MM, but it can only be performed in a small fraction of highly selected patients due to the relatively high treatment-related morbidity and mortality. Despite its valuable role in the treatment of MM, autologous HSCT has its own short-term as well as long-term complications.

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Section: Autologous Hsct In Patients With MM Having Renal Failurementioning

confidence: 99%

Section: Autologous Hsct In Patients With MM Having Renal Failurementioning

confidence: 99%

An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

Al-Anazi¹,

Alshaibani²,

Kalogianidis³

2023

Recent Updates on Multiple Myeloma

View full text Add to dashboard Cite

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Insuffisance rénale dans le myélome multiple : particularités de la prise en charge

Try¹,

Harel²

2024

Bulletin du Cancer

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Autologous stem cell transplantation can potentially reverse dialysis dependence in patients with myeloma: Report of two cases and practical considerations

SINGH,

SHARMA,

SINGH

et al. 2024

NMJI

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Background Autologous stem cell transplantation (ASCT) is potentially beneficial for patients with myeloma-related renal impairment but is associated with high rates of complications in dialysis-dependent patients and requires specific precautions. Methods Patients diagnosed with myeloma and concomitant dialysis-dependent renal dysfunction were admitted for ASCT after achieving at least partial response with bortezomib-based induction therapy. For both patients, mobilization consisted of granulocyte colony stimulating factor for 5 days and CD34 directed Plerixafor on Day 1. Melphalan was administered at a dose of 140 mg/m2 and a pre-emptive session of haemodialysis was planned 24 hours after melphalan. Peripheral blood stem cell infusion was done after 24 hours. A central venous sample for blood gas analysis was obtained daily and ad hoc dialysis was planned at the earliest sign of metabolic acidosis (pH <7.35, HCO3 <15 or K >6 mEq/L). Results Two patients with biopsy proven cast nephropathy and dialysis dependence (twice a week) were taken for ASCT with the above protocol. No variation from usual stem cell yield or engraftment kinetics was noted. Patient 1 (M, 49 years) achieved very good partial response post-transplant and has been dialysis free for 18 months post-ASCT. Patient 2 (M, 48 years) achieved negative immunofixation post-ASCT and was dialysis free for 9 months post-transplant, following which he requires one session of dialysis every 3–4 weeks for onset of uraemic symptoms. Conclusions ASCT in dialysis-dependent patients is associated with a higher risk of drug toxicity, infections and transplant-related mortality. Use of reduced dose melphalan, pre-emptive dialysis after 24 hours and monitoring for acidosis and symptoms of uraemia to identify acidosis at an early stage allows safe administration of high dose chemotherapy. A major proportion of patients can potentially achieve reduction or freedom from dialysis support post-transplant.

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Autologous Hematopoietic Cell Transplantation for Dialysis-Dependent Myeloma: More Efficient, Less Toxic

Cited by 3 publications

References 8 publications

An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

Insuffisance rénale dans le myélome multiple : particularités de la prise en charge

Autologous stem cell transplantation can potentially reverse dialysis dependence in patients with myeloma: Report of two cases and practical considerations

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