Disease recurrence in a transplant kidney in a patient with extramedullary plasmacytoma

Binnani, Pooja; Bahadur, Madan M.; Kedia, Nikhil; Sharbidre, Prakash

doi:10.4103/0971-5851.73600

Cited by 3 publications

(1 citation statement)

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“…Regardless of the plasmacytoma's origin, this appears to be the first case reported of a large plasmacytoma without marrow involvement, fulfilling the International Myeloma Working Group definition of multiple myeloma [ 1 ] by the criteria of renal insufficiency secondary to biopsy-proven cast nephropathy. Although one prior case report described a patient with soft tissue plasmacytoma and myeloma cast nephropathy on renal biopsy, serum free light chains were not quantified in that case and a bone marrow biopsy was not performed prior to systemic therapy [ 15 ]. This presentation was similar to but also distinct from the rare phenomenon of macrofocal myeloma, in which multiple bone plasmacytomas are seen in the absence of bone marrow involvement.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Multiple Myeloma with Light-Chain Cast Nephropathy Secondary to a Very Large Plasmacytoma without Bone Marrow Involvement

Komisarof

Lipof²,

DiTursi

et al. 2022

Case Reports in Hematology

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Here, we report a case of a patient who presented to Strong Memorial Hospital with new-onset renal failure and anemia and was found to have multiple myeloma with lambda light-chain cast nephropathy secondary to a very large (14 cm × 14 cm × 12 cm) plasmacytoma without bone marrow involvement. This case is notable as solitary plasmacytomas are almost never seen with concomitant myeloma-defining CRAB criteria or significantly elevated serum free light-chain ratios. Although solitary plasmacytomas are typically definitively treated with radiation, this case highlights that systemic treatment may be helpful in certain clinical scenarios.

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Section: Discussionmentioning

confidence: 99%

An Unusual Case of Multiple Myeloma with Light-Chain Cast Nephropathy Secondary to a Very Large Plasmacytoma without Bone Marrow Involvement

Komisarof

Lipof²,

DiTursi

et al. 2022

Case Reports in Hematology

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Multiple drugs

2021

Reactions Weekly

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Multiple drugs Relapse of myeloma cast nephropathy and neuropathy: case reportAn approximately 44-year-old man experienced relapse of myeloma cast nephropathy while receiving immunosuppressant therapy with azathioprine, prednisolone and ciclosporin. Additionally, he developed neuropathy during treatment with thalidomide for the relapsed myeloma cast nephropathy.The man with no pre-existing diseases like diabetes, hypertension or any past or family history of renal disease, presented in June 2001 (at the age of 38 years) with four months history of bilateral loin pain, nocturia, weight loss and feeling unwell. After examinations, a diagnosis of myeloma cast nephropathy was made. He was maintained on haemodialysis twice weekly, and received treatment with vincristine, doxorubicin, dexamethasone and thalidomide. With the treatment, partial response was reported. He remained stable after that, but remained dialysis dependent for following two years. In 2003, he underwent kidney transplantation with his sister as a donor, and started receiving immunosuppressant therapy with azathioprine, ciclosporin [cyclosporine] and prednisolone [routes and dosages not stated]. The transplant procedure was uneventful. In July 2007 (aged approximately 44 years), he noticed frothy urine. Urine analysis showed 4+ proteinuria with other abnormal parameters. Urine immunofixation study showed free kappa light chains. He received treatment with thalidomide and steroids for six months, but developed thalidomide therapy-related neuropathy. Bone marrow study showed absence of abnormal cells. Renal graft biopsy done at the transplant center showed 12 glomeruli displaying normal capillary basement membrane, tubules showing fractured hyaline casts surrounded by mononuclear giant cells along with interstitial oedema and marked mononuclear inflammatory cell infiltration. Based on the examination, recurrence of myeloma cast nephropathy in the renal graft was considered.Consequently, the man was hospitalized, and received treatment with doxorubicin and dexamethasone. Due to high serum creatine levels, he required high doses of steroids. He then underwent one session of haemodialysis, which was followed by tumour excision. Examinations of the resected sample showed extensive, hard and irregular mass arising from small bowel mesentery that extended up to the root of mesentery and engulfing superior mesenteric vein. Histological examinations were suggestive of massive plasmacytoma with huge deposits of myeloma protein (95% tumour made up of dense hyaline, partly proteinaceous and partly fibrillar material). Renal parameters returned to baseline levels in one month, and other tests also normalised. Further therapy with dexamethasone and thalidomide was considered. Also, it was considered that the immunosuppressant therapy promoted the rapid tumour growth resulting in the relapse of myeloma cast nephropathy [not all outcomes stated].

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Extramedullary plasmocytoma: A rare malignancy in renal transplant recipient

Dave

Bahadur

Bhat

et al. 2015

Indian Journal of Transplantation

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Available online xxxKeywords: Extramedullary plasmacytoma Post transplant lymphoproliferative disorder (PTLD) Autologous hematopoetic stem cell transplant (AHSCT) Renal transplant a b s t r a c t Extramedullary plasmacytoma in a post renal transplant recipient is an extremely rare type of post transplant lymphoproliferative disorder (PTLD) which warrants significant reduction in immunosuppressive therapy leading to increased risk of rejections and even graft loss. We describe a 49 year old male patient who after 14 years of renal transplant presented with extramedullary plasmacytomas in pancreas, gums, subcutaneous tissue and transplant kidney. He was treated with high dose melphalan followed by rescue autologous hematopoetic stem cell transplant and concurrent reduction in immunosuppression following which he achieved complete remission maintained on 5 years of follow up with astable allograft function. This case, to best of our knowledge is first case to be successfully managed with a rescue autologous hematopoetic stem cell transplant in a renal transplant patient with multifocal extramedullary plasmacytomas.

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Disease recurrence in a transplant kidney in a patient with extramedullary plasmacytoma

Cited by 3 publications

References 2 publications

An Unusual Case of Multiple Myeloma with Light-Chain Cast Nephropathy Secondary to a Very Large Plasmacytoma without Bone Marrow Involvement

An Unusual Case of Multiple Myeloma with Light-Chain Cast Nephropathy Secondary to a Very Large Plasmacytoma without Bone Marrow Involvement

Multiple drugs

Extramedullary plasmocytoma: A rare malignancy in renal transplant recipient

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