Pro-kidney transplantation should be considered in patients with multiple myeloma

Abstract

Multiple myeloma is the most frequent malignant monoclonal gammopathy and the second most common hematological malignancy after non-Hodgkin lymphoma. There continues to be evolving therapies in the treatment which has significantly changed progression-free and overall survival of the patients. Increasingly, evidence shows that multiple myeloma no longer portends poor and lethal prognosis. With the advances in treatment of multiple myeloma and improved survival as seen in several studies, perhaps more attention should focus on kidney transplantation in these individuals given their suboptimal outcomes on dialysis. We would like to propose that a diagnosis of multiple myeloma not be considered as an absolute contraindication for kidney transplantation. Rather, a careful consideration of kidney transplantation is appropriate for a subset of patients with multiple myeloma and end-stage kidney disease. The candidacy of these patients should be reviewed by a multidisciplinary team comprising experts in hematology, kidney transplantation, and key stakeholders (including laboratory medicine, renal pathologists, and pharmacists) to allow appropriate risk stratification, prognostication for a successful and safe kidney transplantation.