Abstract: SA-PO231
Outcome of Patients with Multiple Myeloma Who Undergo Autologous Stem Cell Transplantation Followed by Renal Transplantation: A Case Series Report
Session Information
- Trainee Case Reports - V
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Ibrahim, Maria, National Health Service, Watford, United Kingdom
- Shah, Sapna, Kings College Hospital NHS Foundation Trust, London, United Kingdom
- Benjamin, Reuben, King''s College Hospital, London, London, United Kingdom
- Delaney, Michael, National Health Service, Watford, United Kingdom
- Schey, Steve, King?s College London, London, United Kingdom
Introduction
Autologous stem cell transplantation (ASCT) and novel therapies have improved the prognosis of patients with multiple myeloma (MM). For those who undergo ASCT whilst on dialysis, a similar survival compared with the overall MM population has been reported. For patients achieving remission following ASCT, kidney transplantation is an attractive option, offering an improved quality of life and significant economic advantage.
Case Description
This case series investigates the outcome of 5 subjects who underwent an ASCT for MM with subsequent kidney transplantation.
Subjects were identified from our regional hospitals between 2006 and 2012.
2 females and 3 males were identified. All patients were Caucasian with a median age of 54years (range 37- 64). 4 patients presented with end stage renal disease (ESRD) and 1 progressed to ESRD shortly after diagnosis. Induction chemotherapy regimens with novel agents including thalidomide and bortezomib were utilised. Following attainment of very good partial remission (VGPR) or complete remission (CR), high dose melphalan ASCTs were performed after a median of 11 months (range 8-22months). Kidney transplantation (living donor, n=3, deceased donor, n=2) with tacrolimus based immunosuppression regimens were completed at a median of 27 months after ASCT (range 16-43months). Patients 1 and 3 experienced relapse of myeloma at 40 months and 13 months after kidney transplantation. Patient 1 received bortezomib based treatment to achieve CR, but later relapsed again. He developed sepsis related AKI and commenced dialysis. He died 1 month later. Patient 3 was treated with thalidomide and achieved VGPR. He developed a second relapse 5 months later and died with a functioning allograft (eGFR 21). Patients 2, 4 and 5 remained alive at the end of the follow up period (median time 67months) with eGFRs of 62, 11 and 50 respectively. Median kidney graft survival time was 66 months (range 47–95months).
Discussion
5 patients with MM undergoing ASCT followed by renal transplantation achieved dialysis independence for a median of 66 months. Our study adds to the literature supporting kidney transplantation as the preferred treatment for ESRD following successful ASCT for MM and is useful when counselling patients reagrding renal and haematological outcomes.