Retrospective analysis of the impact of kidney function on the outcomes of first autografts for de novo myeloma patients in the era of novel agents

Flóró, Lajos; Λαζανά, Ιωάννα; Streetly, Matthew; Benjamin, Reuben; Shah, Sapna; Gunning, Douglas; Ware, Stephanie M.; Mahmood, Shameem; Kazmi, M; Schey, Stephen

doi:10.1016/j.clml.2015.07.373

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“…However, since the introduction of novel agents such as bortezomib, thalidomide and lenalidomide, there have been improvements in the rate of response even in patients with renal impairment [7, 8]. Furthermore, after ASCT, a similar survival for patients with ESRD compared with the overall MM population has been reported [1, 9].…”

Section: Introductionmentioning

confidence: 99%

Risk of relapse of multiple myeloma following kidney transplantation

Shah

Ibrahim

Delaney

et al. 2019

Clinical Kidney Journal

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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.

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