Risk of relapse of multiple myeloma following kidney transplantation

Abstract

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 10 months. Kidney transplantation (living donor n = 3, deceased donor n = 2) with tacrolimus-based immunosuppression regimens was completed at a median of 27 months 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 55 months (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. Death-censored 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.

Multiple myeloma and kidney transplantation: the beginning of a new era

“…The article of Shah et al . [22] in this issue of Clinical Kidney Journal further adds to the literature and highlights the challenges faced in MM patients undergoing kidney transplantation [22].…”

“…In their article, Shah et al . [22] report five MM patients with ESRD undergoing kidney transplantation. These patients attained a very good partial remission or complete remission following induction therapy using novel agents, and subsequently underwent high-dose ASCT.…”

“…Kidney transplantation was performed at a median of 27 months after ASCT. Post-transplant immunosuppressive treatment consisted of induction with basiliximab followed by maintenance therapy with tacrolimus, mycophenolate mofetil and prednisolone [22]. Two out of five patients experienced a relapse of MM at 6 and 16 months after kidney transplantation and both patients died (at a median of 52 months post-transplant).…”

“…However, two of these patients experienced allograft rejection and returned to dialysis at a median of 39 months post-transplantation. The three patients without MM relapse are alive at a median time of 55 months post-transplantation resulting in a death-censored graft and patient survival of 80% at 4 years post-transplantation [22].…”

Kidney transplant in multiple myeloma, the challenges, and potentials

“…Only one patient remained alive with a functioning allograft without myeloma relapse 55 months after kidney transplant. 12 Better results were obtained with combined hematopoietic stem cell and kidney transplantation, but the need for a human leukocyte antigen (HLA)–matched donor limits the role of this therapy. 13 In general, although certain patients may benefit from kidney transplantation, significant challenges exist with regard to relapse of multiple myeloma, recurrent cast nephropathy, infection, and rejection.…”