Plasma cell dyscrasias (PCD) are a spectrum of diseases characterized by clonal proliferation of plasma cells secreting a monoclonal immunoglobulin. Although considered an incurable disease, a combination of autologous stem cell transplant with novel therapies, including lenalidomide, has improved the overall and progression-free survival of these patients. Renal impairment is an important complication of the disease that, in some cases, progresses to end-stage renal disease. Due to the characteristics of PCD, traditionally these patients have not been candidates for renal transplantation. However, treatment improvement allows a reconsideration of this perception, especially in younger patients with good performance status and treatment response. We report two cases of patients diagnosed with PCD undergoing renal transplantation after autologous stem cell transplantation, both cases under treatment with lenalidomide. We also report their perioperative management and their outcome.
This case highlights that clinicians should be aware of the possibility of severe neurological toxicity after the administration of ifosfamide and may control the risk factors associated.
Guidelines recommend autologous stem cell transplantation (ASCT) consolidation in first complete or partial response after regimens including rituximab (R) and high-dose AraC (HDAC), but its use beyond that response is questioned. We present a retrospective analysis of 268 patients with MCL who received ASCT. With a median follow-up for survival patients of 54 months, progression-free survival and overall survival for the whole series were 38 and 74 months, respectively, and for patients transplanted in first CR 49 and 97 months, respectively. Patients without CR before transplant were analyzed separately, those who achieved CR after transplantation had better PFS (48 vs 0.03 months, p < 0.001) and OS (92 vs 16 months, p < 0.001) than the remaining. In univariate analysis, first CR at transplant (p = 0.01) and prior rituximab (p = 0.02) were the variables associated with PFS. For OS, the same variables resulted significant (p = 0.03 and p < 0.001, respectively). In multivariate analysis, only the status at transplant (first CR) remained significant. This retrospective study concludes that ASCT consolidation in first CR induces high survival rates. In other stages of disease, the need of ASCT as consolidation may be questioned.
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