Chronic Lymphocytic Leukemia: A Hazardous Condition Before Kidney Transplantation

Abstract

Long-term survival of patients with chronic lymphocytic leukemia (CLL) is over 10 years, and such patients are thus potential kidney recipients in the case of superimposed end-stage renal disease. However, the renal and patient outcome in this condition is unknown. We report the charts of four patients with CLL who were engrafted in France with a deceased-donor kidney and underwent routine triple immunosuppressive therapy. The results show that these patients developed severe infectious episodes (fatal in one case) and tumoral complications including rapid progression of CLL in two cases. Moreover, the graft may be infiltrated and damaged by monoclonal B cells: one patient lost his graft 14 months after transplantation. Various therapeutic options (modifications of the immunosuppressive regimen, anti-CD20 antibodies, irradiation of the graft) showed little (if any) efficacy. Therefore, we believe that CLL is a too hazardous condition to envisage solid organ transplantation with a routine immunosuppressive regimen, and we propose a more appropriate approach.

Solid organ transplant in individuals with monoclonal B‐cell lymphocytosis and chronic lymphocytic leukaemia

“…Up to 10% of CLL patients develop RT; risk factors include advanced stage and unfavourable prognostic factors (such as CD38, ZAP70 and CD49d positivity, presence of trisomy 12, deletion 11q or deletion 17p) (Parikh & Shanafelt, ). None of the patients in the series reported by d'Ythurbide et al () or the present series developed PTLD, and only 1 patient (from the French series; d'Ythurbide et al , ) developed RT. Although the cumulative sample size remains small, these data do not suggest a clear increased risk of PTLD or RT in patients with CLL/MBL undergoing SOT.…”

“…This report, along with the four patients reported from the French Registry of Kidney Transplantation (d'Ythurbide et al , ), provides the only published information on the outcome of SOT in CLL/MBL.…”

“…There are also concerns that the risk of post‐transplant lymphoproliferative disorders (PTLD) may be more common in patients with CLL. For these reasons, the presence of MBL or CLL is often considered a contra‐indication to SOT (d'Ythurbide et al , ).…”

“…To date, only one case series of four patients with CLL who underwent SOT has been published (d'Ythurbide et al , ), and investigators have urged that additional cases, with good or poor outcome, be reported (d'Ythurbide et al , ).…”

Chronic lymphocytic leukemia associated with immunotactoid glomerulopathy: a case report of successful treatment with high-dose methylprednisolone in combination with rituximab followed by alemtuzumab

“…Previous case reports have documented the efficacy of rituximab in CLL-associated GD, with significant reduction of proteinuria, improvement in renal function, and parallel control of the underlying CLL 17 . However, in those reports there is no description of the duration of response or long term follow up as we report here.…”