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. 2022 Jan 10;7(4):752-762.
doi: 10.1016/j.ekir.2022.01.003. eCollection 2022 Apr.

Kidney Transplant Outcomes of Patients With Multiple Myeloma

Cihan Heybeli  1 , Andrew J Bentall  2 , Mariam Priya Alexander  3 , Hatem Amer  2 , Francis K Buadi  4 , Angela Dispenzieri  4 , David Dingli  4 , Morie A Gertz  4 , Naim Issa  2 , Prashant Kapoor  4 , Aleksandra Kukla  2 , Shaji Kumar  4 , Elizabeth C Lorenz  2 , S Vincent Rajkumar  4 , Carrie A Schinstock  2 , Nelson Leung  2   4
Affiliations

Kidney Transplant Outcomes of Patients With Multiple Myeloma

Cihan Heybeli et al. Kidney Int Rep. .

Abstract

Introduction: Data on kidney transplantation (KTx) outcomes of patients with multiple myeloma (MM) are very limited.

Methods: We investigated the outcomes of patients with MM who underwent KTx between 1994 and 2019.

Results: A total of 12 transplants from 11 patients were included. At the time of KTx, 6 were classified as having stringent complete response (CR), 2 as CR, 2 as very good partial response (VGPR), and 2 as partial response (PR). With a median follow-up of 40 (minimum-maximum, 5-92) months after KTx, hematologic progression occurred in 9 transplants (75%). There were 3 grafts (25%) that failed, and 5 patients (45.5%) experienced death with functioning allografts. Graft survival at 1 and 5 years was 82.5% and 66%, respectively. Progression-free survival (PFS) rates of the cohort at 1, 3, and 5 years were 83.3%, 55.6%, and 44.4%, respectively. The estimated median PFS of patients who received bortezomib at any time (pre-KTx and/or post-KTx) was not reached, whereas it was 24 months for those who never received bortezomib (P = 0.281). Overall survival (OS) rates of the cohort at 1, 3, and 5 years were 81.8%, 61.4%, and 61.4%, respectively. OS of patients who received bortezomib at any time was 87.5%, 72.9%, and 72.9%, and that for those who never received bortezomib was 66.7%, 33.3%, and 33.3% (P = 0.136). All deaths occurred owing to hematologic progression or treatment-related complications.

Conclusion: Kidney transplant outcomes of patients with myeloma who received bortezomib before or after KTx seem to be more favorable. Nevertheless, relapse after KTx in MM is still common. More studies are needed to better determine who benefits from a KTx.

Keywords: chronic kidney failure; graft survival; kidney transplantation; mortality; multiple myeloma; recurrence.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Courses of each patient after kidney transplantation. Timing of relapse episodes, their treatments, and outcomes for kidney allografts and patients are also revealed. Protocol biopsies were available except patients 1, 2, and 11 (both first and second transplants). ASCT, autologous stem-cell transplantation; CR, complete response; CyBorD, cyclophosphamide/bortezomib/dexamethasone; DEX, dexamethasone; KTx, kidney transplantation; IF, immunofixation; IHC, immunohistochemistry (of bone marrow); MDS, myelodysplastic syndrome; MRD, minimal residual disease; PR, partial response; PRED, prednisone; REV, lenalidomide; sCR, stringent complete response; THAL, thalidomide; VAD, vincristine, adriamycin, dexamethasone; VBCMP, vincristine, carmustine, melphalan, cyclophosphamide, and prednisone; VEL, bortezomib; VGPR, very good partial response; VRD, bortezomib/lenalidomide/dexamethasone.
Figure 2
Figure 2
PFS rates at 1, 3, and 5 years of patients who received bortezomib at any time were 87.5%, 72.9%, and 54.7%, whereas PFS rates of patients who never received bortezomib were 75%, 50%, and 25%, respectively (P = 0.281). PFS, progression-free survival.
Figure 3
Figure 3
The 1-, 3-, and 5-year OS rates of patients who were treated with bortezomib at any time were 87.5%, 72.9%, and 72.9%, whereas OS rates for those who never received bortezomib were 66.7%, 33.3%, and 33.3%, respectively (P = 0.136). OS, overall survival.
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