Abstract: SA-PO0186
Autologous Stem-Cell Transplant for Management of Monoclonal Gammopathy of Renal Significance
Session Information
- Onconephrology: MGRS, HSCT, Electrolytes, RCC, and More
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Maharaj, Sime, Weill Cornell Medicine, New York, New York, United States
- Seshan, Surya V., Weill Cornell Medicine, New York, New York, United States
- Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction
Monoclonal gammopathy of renal significance (MGRS) is a clonal proliferative disease characterized by nephrotoxic proteins leading to various kidney pathologies. MGRS lacks non-renal manifestations of plasma cell dyscrasias. Treatment aims to preserve kidney function and eradicate the malignant clone. We present a case of MGRS associated with proximal tubular light chain deposition treated with autologous stem cell transplant (ASCT).
Case Description
A 64 year old male presented to renal clinic with elevated serum creatinine (SCr) 1.5 mg/dL (0.6-1.3) noted 6 months ago, from a baseline of 1.0 mg/dL. His only complaint was nocturia. Two years prior to presentation, he was diagnosed with a solitary plasmacytoma of the C6 vertebra. Bone marrow biopsy showed minimal involvement by plasma cell neoplasm, <5% involvement by CD138 immunohistochemistry with kappa light chain restriction. He underwent resection followed by radiation. Physical exam was unremarkable. Remaining labs were significant for kappa free light chains (kFLC) 38.9 mg/dL and kappa to lambda ratio (k/L) of 35.93. Urinalysis was bland, without proteinuria. Patient was observed until 10 months after clinic presentation, when urine protein to creatinine ratio rose to 0.6, with kFLC of 84.07mg/dL and k/L of 76.43. sCr was 1.6 mg/dL. Kidney biopsy revealed diffuse proximal tubulopathy, with monoclonal kappa light chain restriction, crystalline and non crystalline deposits (light chain proximal tubulopathy) and occasional glomerular epithelial involvement (Fig 1). His renal function and proteinuria worsened, therefore he underwent six cycles of daratumumab, cyclophosphamide, bortezomib and dexamethasone followed by ASCT. Six months later, kFLC improved to 0.59 mg/dL and proteinuria resolved. sCr returned to a new baseline of 1.2 mg/dL.
Discussion
Our case illustrates that chemotherapy and ASCT can successfully treat MGRS, leading to reversal of kidney dysfunction.