MPN-166 Myeloproliferative Neoplasm (MPN) Post-Renal Transplant (RT)-A Single-Center Review.

Abstract

MPN post-RT is a rare disease. There is little data on the clinicopathological features and outcomes of patients with post-RT MPN. The main objective of this study was to analyze the clinical outcome of MPN post-RT. This was a single-center retrospective study Settings: Patients who had post-RT MPN at Memorial Herman Hospital, Texas Medical Center. We reviewed 1998 patients who underwent RT between January 1, 1999, and December 31, 2019. Three cases of post-RT MPN were identified. None Main Outcome Measures: We analyzed the incidence, the interval between RT and MPN diagnosis, MPN treatment, and clinical outcome of patients with post-RT MPN. Among 1998 RT recipients, 3 cases (0.1%) of MPN were identified. All occurred in women with a mean age of 53 years. Races were African American (n=2) and white (n=1). Causes of end-stage renal disease were diabetes, hypertensive, and IgA nephropathy. Two patients received RT, and one patient simultaneous kidney and pancreas transplant. All three patients were on tacrolimus, mycophenolate, and prednisone for post-transplant immunosuppression. Two patients developed chronic myeloid leukemia (CML), and one had polycythemia vera (PV). The mean interval between RT and diagnosis of MPN was 9 years. Cytogenetics demonstrated JAK-2 mutation in the patient with PV and BCR-ABL translocation in the two CML patients. The CML patients received BCR-ABL tyrosine kinase inhibitors (TKIs; imatinib/dasatinib) and continue to have a major molecular response. The patient with PV remains on hydroxyurea (HU) and aspirin with excellent hematocrit control. Mycophenolate was discontinued in all three patients after the diagnosis of MPN. TKI and HU were well tolerated. No thrombotic events or leukemic transformation were reported. One CML patient developed cytomegalovirus colitis. No other infectious complications were noted. She also developed immune-related hemolytic anemia and thrombocytopenia that were successfully treated with glucocorticoids. All three patients still have preserved allograft function and are alive at a median follow-up of 42 months. MPN post-RT is rare. Standard-of-care therapies for MPN are well tolerated. Further studies are required to explore the pathophysiology and outcomes of MPN in RT recipients.