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Published on: May 1, 2015
Multiple myeloma after kidney transplantation
Sami Safadi1, Angela Dispenzieri, Hatem Amer
1Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Background:
Data regarding multiple myeloma (MM) that develops after kidney transplantation (KTx) are scarce. The outcomes of these patients were evaluated in a retrospective study.
Methods:
Patients with newly diagnosed MM after KTx were selected. Patients with a diagnosis of MM or those who received treatment for monoclonal gammopathy of renal significance (MGRS) prior to KTx were excluded.
Results:
Between 2001 and 2012, seven patients developed MM after KTx. Reasons for ESRD included ADPKD (1), C1q nephropathy (1), MPGN (2), hypertensive nephrosclerosis (2), and chronic interstitial nephritis (1). Before KTx, only four patients had monoclonal protein studies, four had monoclonal gammopathy of undermined significance (MGUS), and two of them had clonal plasma cells in bone marrow. Median follow-up after MM was 70 months (range 19-100). Median survival was 80 months. Median time from KTx to MM was 72 months (range 3-204 months). The Kidney allograft failed in four patients due to monoclonal protein-related renal disease. Five patients received chemotherapy: bortezomib (n = 3), lenalidomide (n = 2), melphalan (n = 1), thalidomide (n = 1), pomalidomide (n = 1), and high-dose dexamethasone (n = 1). Three patients received ASCT.
Conclusion:
Multiple myeloma after KTx is rare. Most patients who develop MM had MGUS prior to KTx. There is significant renal involvement in these patients. Survival is not worse when compared to MM without KTx. Further work is needed to identify the best treatment options for these patients.
Insights
Multiple myeloma (MM) after kidney transplantation (KTx) is rare but can occur. Patients often have a history of monoclonal gammopathy of undetermined significance (MGUS) and may experience renal complications, though survival is comparable to MM without KTx.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Multiple myeloma (MM) developing post-kidney transplantation (KTx) is infrequently documented.
- Outcomes for MM patients who have undergone KTx require further investigation.
Purpose of the Study:
- To evaluate the characteristics and outcomes of patients who develop MM after KTx.
- To assess the impact of MM on kidney allograft survival and overall patient prognosis.
Main Methods:
- Retrospective analysis of patients diagnosed with MM after KTx between 2001 and 2012.
- Exclusion of patients with pre-existing MM or treatment for monoclonal gammopathy of renal significance (MGRS) before KTx.
Main Results:
- Seven patients developed MM post-KTx, with diverse underlying causes for end-stage renal disease (ESRD).
- Four patients experienced kidney allograft failure due to monoclonal protein-related renal disease.
- Median survival post-MM diagnosis was 80 months; treatments included chemotherapy and autologous stem cell transplantation (ASCT).
Conclusions:
- MM following KTx is a rare occurrence, frequently preceded by monoclonal gammopathy of undetermined significance (MGUS).
- Significant renal involvement is noted in these patients.
- Survival outcomes for MM post-KTx appear comparable to those without a transplant history, warranting further research into optimal therapeutic strategies.
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