MON-199 KIDNEY TRANSPLANTATION IN MULTIPLE MYELOMA: CASE REPORTS

Abstract

Renal transplantation is traditionally contraindicated in Multiple Myeloma (MM) due to increased risk of post-transplant disease recurrence and associated complications. However, with recent advances in MM treatment modalities and overall survival, renal transplant centers are reporting increasing success in carefully selected groups of patients with treated plasma cell dyscrasias. We hereby present our experience through 3 case reports. A 72-year-old Caucasian male with IgG smoldering MM, and end stage diabetic nephropathy, received prophylactic Bortezomib chemotherapy for high lambda light chain burden, 6 months prior to an ABO incompatible living related kidney transplant in 2015. A stable renal function and ongoing hematological remission without further maintenance therapy was achieved for the next 24 months. MM progression in the form of gastrointestinal amyloidosis and plasma cell infiltration of his renal allograft was diagnosed 2 years post transplant. This was successfully mitigated with further cycles of Bortezomib containing chemotherapy, stabilizing his serum creatinine around 180umol/L. A 68-year-old Caucasian male, with stage 3 lambda light chain MM and end stage cast nephropathy was evaluated for renal transplantation. Hematological remission was achieved through Bortezomib based induction and subsequent autologous stem cell transplant, with thalidomide maintenance therapy. Unfortunately, no suitable living related donor was available, and he received a cadaveric renal transplant 2.5 years later in 2017. 10 months post transplant, he was diagnosed with CMV pneumonitis, and required CMV immunoglobulin therapy as a consequence of residue hypogammaglobulinemia secondary to his MM. His renal function has remained stable post transplant with a baseline serum creatinine of 120umol/L. A 49-year-old Greek female, with end stage cast nephropathy secondary to stage 3 kappa light chain MM. Remission of her myeloma was achieved through Bortezomib containing induction therapy followed by an autologous stem cell transplant. She subsequently underwent a successful ABO incompatible living related kidney transplant 10 months later in 2018. Her allograft function has remained stable with a serum creatinine of 90umol/L. Sustained renal allograft function can be achieved in MM patients with hematological remission, improving quality of life off dialysis whilst broadening myeloma treatment options previously limited by end stage renal failure. Logistically, living related donors provide a favorable option, significantly reducing the duration of wait time and risk of further deterioration. Unique complications associated with underlying MM, in the form of disease recurrence or increased predisposition to opportunistic infections can occur post renal transplant. However, early recognition and mitigation will ensure perseverance of allograft function.