Neoplastic and non‐neoplastic complications of solid organ transplantation in patients with preexisting monoclonal gammopathy of undetermined significance

Goebel, Teresa E.; Schiltz, Nicholas K.; Woodside, Kenneth J.; Pillai, Aiswarya Chandran; Caimi, Paolo; Lazarus, Hillard M.; Koroukian, Siran M.; Campagnaro, Erica

doi:10.1111/ctr.12595

Cited by 11 publications

(7 citation statements)

References 35 publications

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“…Serum paraprotein analysis prior to organ transplantation was only performed for one patient in our series and the possibility of before transplantation as it lacks prognostic value. 59,60 No increase in the risk of progression of PT-MGUS to PCM has also been documented by several investigators. 56,57 Moreover, spontaneous resolution of MGUS has been reported in 21%-37% of solid organ allograft recipients, compared to 2% of non-transplant patients.…”

Section: Morphology and Immunophenotypementioning

confidence: 75%

The clinical and pathological features of plasma cell myeloma post solid organ transplantation

et al. 2020

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Plasma cell neoplasms (PCNs), comprising plasma cell myelomas (PCMs) and plasmacytomas, which occur after solid organ transplantation, represent rare subtypes of monomorphic post-transplant lymphoproliferative disorders (M-PTLDs). Data regarding the clinical and pathological features of post-transplant (PT)-PCMs are limited. To gain a better understanding of disease biology, we performed comprehensive immunophenotypic analysis, reviewed cytogenetic analysis results and evaluated clinical outcomes of PT-PCMs diagnosed and treated at our institution. Fifteen PT-PCM (M: F-4:1) and two PT-MGUS (two males) cases were identified. The median age of PT-PCM patients was 68 years (29-79 years) and PCMs presented at a median of 9.7 years (0.5-24.7 years) after transplantation. The PT-PCMs accounted for 11.6% of all M-PTLDs and the period prevalence was 9/3108 (0.29%), 3/1071 (0.28%), 2/1345 (0.15%) and 1/878 (0.11%) post kidney, heart, liver and lung transplantation. Lytic bone disease was observed in 1/11 (9%) patients. Marrow plasma cell infiltration ranged from 10%-70% (median 20%), with 10/15 (67%) and 5/15 (33%) cases manifesting immature and plasmablastic morphology. The immunophenotype of all cases and cytogenetic abnormalities, identified in 60% of cases, were similar to multiple myeloma (MM) of immunocompetent individuals. All PT-PCMs were EBER negative. Ten of 11 (91%) patients with active MM were treated, all with proteasome inhibitor-based therapy. Treatment response and 5-year overall survival (54.5%) was comparable to MM of immunocompetent individuals. However, the survival of patients with plasmablastic PCMs was inferior to those with immature PCMs. 0ur findings indicate PT-PCMs to be predominantly late onset PTLDs that have similar clinicopathologic characteristics as conventional MM.

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Section: Morphology and Immunophenotypementioning

confidence: 75%

The clinical and pathological features of plasma cell myeloma post solid organ transplantation

et al. 2020

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“…In contrast, a long-term follow-up of five transplant recipients with MGUS showed that two had developed smoldering myeloma, six and 10 years after the initial diagnosis, respectively [10]. A recent large cohort study of MGUS patients with or without solid organ transplant showed that transplantation did not significantly affect the risks of malignant progression, infection and thrombosis [11]. Furthermore, although B cell is suppressed by immunosuppression including steroid, these might prevent abnormal B cell proliferation and myeloma.…”

Section: Discussionmentioning

confidence: 94%

Short-term outcome and quality of life in kidney transplant recipient with monoclonal gammopathy

et al. 2016

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Monoclonal gammopathy of undetermined significance (MGUS) is the common pre-malignant B cell disorders with a general prevalence of 3-5 % at age over 50. Because of the potential malignant transformation and immune insufficiency, pre-transplant MGUS recipient should be carefully followed after allograft transplantation. The post-transplant prognosis and quality of life (QOL) in patient with MGUS have not yet been fully determined. The aim of this study is to evaluate function and pathology of the renal allograft and self-assessment QOL changes during 2 years after transplantation in our case of MGUSbearing recipient. We here studied the clinical course and QOL improvement before and 20 months after transplant in a 56-year-old woman, who had pre-existing MGUS and underwent living donor kidney transplantation. After the renal allograft transplant, the patients maintained normal GFR and had neither acute rejections nor histologic evidence of renal injuries related to the monoclonal gammopathy on the protocol biopsy of 1 year post-transplant. During further 20 months follow-up, the pre-transplant MGUS remained uneventful without any hematologic abnormalities and other medical complications, i.e., infection. Evaluation of QOL using a self-assessment questionnaire showed significant improvement for physical and mental items on both 6 and 18 months post-transplant. The renal transplant thus successfully provided a greater satisfaction for the recipient on both physical and mental health aspects. Our observations suggest that renal transplantation is beneficial even in those who had pre-existing

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“…7 In a retrospective analysis of the Healthcare Cost and Utilization Project in California, only 72 of 22 062 organ-transplant patients had a known MGUS prior to OT (0.3%). 8 Another large retrospective analysis of 1593 organ-transplant patients revealed a monoclonal spike in 2.8% of patients. 9 Some degree of selection bias may be present in these results-as many transplant centers will not list or transplant patients with MGUS.…”

Section: Mgus In Solid Organ Transplantmentioning

confidence: 99%

Plasma cell diseases and organ transplant: A comprehensive review

Cowan

Johnson

Libby

2018

American Journal of Transplantation

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Plasma cell diseases are a class of hematologic diseases that are sometimes present as preexisting diagnoses prior to organ transplantation, causative factors leading to a need for organ transplantation, or may occur posttransplant as part of the spectrum of posttransplant lymphoproliferative disorders. Herein, we review the most common plasma cell diseases, both as coexisting with other causes of organ failure, but also as a primary underlying cause for organ failure. In many cases, treatment of the underlying clonal disease may be indicated before proceeding with organ transplant. This review aims to provide current and relevant data regarding the management of these conditions in the organ transplant patient, for transplant providers, and those who take care of these patients.

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Neoplastic and non‐neoplastic complications of solid organ transplantation in patients with preexisting monoclonal gammopathy of undetermined significance

Cited by 11 publications

References 35 publications

The clinical and pathological features of plasma cell myeloma post solid organ transplantation

The clinical and pathological features of plasma cell myeloma post solid organ transplantation

Short-term outcome and quality of life in kidney transplant recipient with monoclonal gammopathy

Plasma cell diseases and organ transplant: A comprehensive review

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