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Published on: May 18, 2018
Donor-Derived Metastatic Melanoma and Checkpoint Inhibition
S M Boyle1, N Ali2, A J Olszanski2
1Division of Nephrology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Abstract:
Donor-derived malignancy, particularly melanoma, is a rare but known complication of organ transplantation. Here we describe a case of metastatic melanoma in a deceased-donor kidney transplant recipient. After diagnosis, the patient was successfully treated with cessation of immunosuppression, explantation of the renal allograft, and novel melanoma therapies, including the mutation-targeted agents dabrafenib and trametinib and the immune checkpoint inhibitor nivolumab. These 2 new classes of melanoma therapy have revolutionized the course of metastatic melanoma, altering it from one of nearly certain mortality to one of potential cure. This case reviews the mechanisms of action of these therapies and reports our experience with them in the rare setting of donor-derived melanoma in a dialysis-dependent patient.
Insights
Donor-derived melanoma is a rare complication of kidney transplants. This case shows successful treatment with immunosuppression withdrawal, allograft removal, and targeted melanoma therapies.
Area of Science:
- Oncology
- Transplantation Immunology
- Nephrology
Background:
- Donor-derived malignancy is a rare but serious complication following organ transplantation.
- Metastatic melanoma poses a significant challenge in transplant recipients due to immunosuppression.
Observation:
- A case of metastatic melanoma was diagnosed in a deceased-donor kidney transplant recipient.
- The patient presented with a rare complication of donor-derived malignancy.
Findings:
- Successful treatment involved cessation of immunosuppression, explantation of the renal allograft, and novel melanoma therapies.
- The patient received targeted agents (dabrafenib, trametinib) and an immune checkpoint inhibitor (nivolumab).
Implications:
- This case highlights the potential efficacy of modern melanoma therapies in managing donor-derived malignancies.
- The successful outcome demonstrates a shift from near-certain mortality to potential cure for metastatic melanoma in this context.
- Experience with targeted agents and immune checkpoint inhibitors in dialysis-dependent patients with donor-derived melanoma is reported.
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