Abstract: TH-PO595
Successful Treatment and Five Years Disease-Free Survival in a Donor Transmitted Metastatic Melanoma with Ipilimumab Therapy
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Singh, Priyamvada, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Bucktowarsing, Bhavnish, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Pesavento, Todd E., Ohio State University, Columbus, Ohio, United States
- Olencki, Thomas, Ohio State University, Columbus, Ohio, United States
Introduction
Approximately 7% of deceased donors have unknown cancer at the time of organ procurement. More than 50% of these have no apparent contraindication to organ donation. The commonest transmitted malignancy is renal cell cancer (19%), followed by melanoma (17%). Donor transmission of melanoma is often fatal as it is commonly metastatic at the time of diagnosis. Cases with remission following transplant nephrectomy and withdrawal of immunosuppression are few. To our knowledge this is only the second case of donor-derived melanoma that was successfully treated with Ipilimumab. Our patient has the longest disease-free survival (five years) reported in the literature till date.
Case Description
66-year-old female, status post deceased donor Kidney transplant in December 2012 for diabetic nephropathy received a 5/6 HLA-mismatched kidney, underwent induction with basiliximab and glucocorticoid followed by maintenance with tacrolimus and mycophenolate. In March 2013, she developed acute deterioration of allograft function. MRI abdomen/pelvis was suspicious for neoplastic involvement of the allograft with metastases to spleen and bone marrow. Biopsy of the posterior iliac spine and sacrum was positive for metastatic melanoma. Explantation of the allograft on 3/15/2013 showed metastatic involvement. Immunosuppressants were discontinued, and she was initiated on dialysis. Her melanoma was BRAF V600E mutation favorable. Staging studies confirmed widespread metastases involving the bone, liver, spleen, and lungs (TxNxM1c stage IV, allograft-associated). On 4/2013, she was started on vemurafenib (960 mg bid) but was discontinued in August 2013 due to several cutaneous lesions. She was then treated with four cycles of Ipilimumab (3 mg/kg, every three weeks, 8/13/13-10/15/13) without significant side-effects. Quality of life improved. No further progression of cancer was evident on serial imaging and she has been in remission for five years.
Discussion
Despite careful donor selection, cancer transmission to the recipient is inevitable. Early diagnosis, cessation of immunosuppression to allow rejection of the allograft and transplanted cancer cells, transplant nephrectomy, and treatment with chemotherapy/immunotherapy can improve survival. The role of HLA mismatch in prognosis is unclear and a topic for future research.