Abstract: TH-PO0171
Kidney Transplantation Post-Chimeric Antigen Receptor T Cell Therapy in Multiple Myeloma
Session Information
- Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Khan, Zahraa, Weill Cornell Medicine, New York, New York, United States
- Landau, Heather, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Dadhania, Darshana M., Weill Cornell Medicine, New York, New York, United States
- Shaikh, Aisha, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Introduction
Multiple myeloma (MM) is the leading cause of kidney failure among patients with cancer. Kidney transplantation is rarely performed in MM due to the incurable nature of the MM and concerns regarding immunosuppression (IS). Chimeric antigen receptor (CAR) T-cell against B-cell maturation antigen is approved for relapsed/refractory multiple myeloma. Here, we describe a case of successful kidney transplantation in a patient with end stage kidney disease (ESKD) secondary to MM following CAR T-cell therapy.
Case Description
71-year-old man with MM-related ESKD on hemodialysis presented to our oncology clinic for management of MM. He had received multiple lines of therapy including bortezomib-dexamethasone, carfilzomib-lenalidomide-dexamethasone, and daratumumab-bortezomib-dexamethasone. Bone marrow biopsy showed 20%-25% plasma cells, of which 97% were abnormal. CAR T-cell therapy was given for cytoreduction of MM and to improve kidney transplant eligibility. 1-year following CAR T-cell therapy, he achieved a very good partial hematologic response and underwent a living donor kidney transplant. Basiliximab for given for induction IS, followed by tacrolimus, and mycophenolate mofetil (MMF). His intra-operative course was complicated by acute blood loss and acute kidney injury (AKI). His serum creatinine (sCr.) stabilized at 1.76 mg/dL. Post-transplant course was notable for hypogammaglobulinemia, BK viremia and AKI (sCr. 3.5 mg/dL) necessitating lowering of MMF dose and administration of intravenous immunoglobulin. Kidney biopsy at the time of peak BK viremia and AKI revealed diffuse active T-cell mediated rejection Banff1B and negative immunostaining for SV40. He was treated with corticosteroids. At last follow up, 7 months post-transplant, BK viremia had resolved, sCr.was 1.9 mg/dl and estimated glomerular filtration rate of 37 ml/min. He had no evidence of MM relapse.
Discussion
This case highlights the potential role and the challenges of kidney transplantation in patients with MM following CAR T-cell therapy, given the increased risk of infectious complications. Long-term follow-up is essential to monitor for MM relapse and allograft function. Kidney transplantation may be a feasible option for highly selected patients with MM. To our knowledge, this is the first reported case of kidney transplantation following CAR T-cell therapy in a patient with ESKD secondary to MM.