Hematopoietic stem cell transplantation in patients with chronic kidney disease

Area of Science:

• Nephrology
• Hematology
• Oncology

Background:

• Patients with chronic kidney disease (CKD) face high risks with traditional hematopoietic stem cell transplantation (HSCT).
• CKD complicates HSCT due to conditioning regimen toxicity and post-transplant care challenges.
• Exclusion from HSCT has significant consequences, particularly for myeloma patients with CKD.

Purpose of the Study:

• To explore the feasibility and outcomes of HSCT in patients with CKD and end-stage renal disease (ESRD).
• To evaluate the role of reduced-intensity conditioning allogeneic HSCT in CKD patients.
• To assess simultaneous allogeneic HSCT and kidney transplantation for myeloma patients with ESRD.

Main Methods:

• Review of HSCT outcomes in patients with varying degrees of CKD, including ESRD.
• Analysis of reduced-intensity conditioning regimens in allogeneic HSCT for CKD patients.
• Evaluation of simultaneous HSCT and kidney transplantation in ESRD myeloma patients with suitable donors.

Main Results:

• Autologous HSCT in advanced CKD/ESRD shows acceptable outcomes but limited cure rates.
• Allogeneic HSCT with reduced-intensity conditioning is increasingly used for nonmalignant and malignant conditions in CKD.
• Simultaneous HSCT and kidney transplantation offers a combined treatment for myeloma and ESRD, avoiding dialysis.

Conclusions:

• HSCT in CKD patients is evolving, with reduced-intensity allogeneic approaches showing promise.
• Simultaneous HSCT and kidney transplantation presents a viable, potentially curative option for select myeloma patients with ESRD.
• This combined approach mitigates risks associated with dialysis and immunosuppression post-transplant.