Abstract: TH-PO1014

Patients with ESRD Secondary to a Plasma Cell Dyscrasia: The Combined Transplantation Is a Good Option

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Redondo navarro, Beatriz, Hospital 12 de Octubre, Madrid, Madrid, Spain
  • Moliz, Candela, Hospital 12 de Octubre, Madrid, Madrid, Spain
  • Molina, Maria, Hospital 12 de Octubre, Madrid, Madrid, Spain
  • Morales, Enrique, Hospital 12 de Octubre, Madrid, Madrid, Spain
  • Praga, Manuel, Hospital 12 de Octubre, Madrid, Madrid, Spain
  • Gonzalez monte, Esther, Hospital 12 de Octubre, Madrid, Madrid, Spain
  • Andres, Amado, Hospital 12 de Octubre, Madrid, Madrid, Spain
Background

Plasma cell dyscrasias (PCD) are due to an abnormal proliferation of a single clone of plasma or lymphoplasmacytic cells leading to secretion of immunoglobulin (Ig) or an Ig fragment and are a known cause of end stage renal disease (ESRD). Traditionally, renal transplantation (RT) has been avoided in these patients due to the poor patient survival, the risk of recurrence in renal allograft and the high incidence of life threatening infections. However, the improving result of stem cell transplantation (SCT) in combination with the new drug in PCD patients with ESRD has encouraged to considerer in them a RT therapy.

Methods

We performed a retrospective study that included all patients with PCD who have received both SCT and RT in our hospital. We reviewed renal and haematological evolution, infections complications and recipient and RT survival after 3 year of follow-up.

Results

We included 6 patients: 4 (67%) males, median age 55 years old (49-57). The causes of ESRD were: 2 cast myeloma, 2 light-chain diseases, 1 primary amyloidosis and 1 focal segmental glomerulosclerosis. The causes of PCD were: 5 multiple myeloma and 1 primary amyloidosis. 4 (67%) of the patients received SCT 4 before RT and 2 (33%) after RT. The median creatinine at 1 and 3 year were 1.6 (1.1-1.9) and 1.3 (1.1-1.9) mg/dl, respectively. After 3 years of follow-up, renal graft survival non-death censored was 83 %. 5 episodes of infections that need admission occurred in 3 patients: 2 Aspergillus, 2 viral infections and 1 urinary infection. 3 patients developed a recurrence of their PCD: 2 had a remission after treatment with lenalidomide (one partial and the other one complete remission) and 1 patient finally died 15 months. Patient survival at the end of follow-up was 83%.

Conclusion

Sequential SCT and RT could be a suitable option for patients with PCD and ESRD. The patient and renal graft survival arte conditioned to the relapse of hematological disease and infections complications. The high incidence of fungal infection will require special prophylaxis measure. These results highlight the importance of declaring more number of patients in this situation and with longer follow-up to elucidate the best management of PCD with ESRD.