Abstract: FR-PO1277
Kidney Transplantation After Teclistamab-Induced Remission in Relapsed Multiple Myeloma
Session Information
- Onconephrology: Diagnostic Dilemmas, Therapy-Related Toxicities, and Clinical Cases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Ravi, Divya, University of California San Francisco, San Francisco, California, United States
- Wolf, Jeffrey L., University of California San Francisco, San Francisco, California, United States
- Martin, Thomas, University of California San Francisco, San Francisco, California, United States
- Webber, Allison B., University of California San Francisco, San Francisco, California, United States
Introduction
Relapsing multiple myeloma (MM) is often a contraindication to kidney transplantation. Bispecific T-cell engager antibodies show promise in achieving durable responses for relapsing disease. We present a case of a patient with relapsing lambda light chain MM treated with teclistimab(Tec) who underwent successful living donor kidney transplant.
Case Description
A 71 -year-old male was diagnosed in 2012 with lambda light chain MM. He received bortezomib-based induction followed by autologous stem cell transplant in 2013 and lenalidomide maintenance until 2016. After relapse in 2017, he was treated with daratumumab/lenalidomide/dexamethasone. In 2019, he developed acute kidney injury and kidney biopsy showed AL lambda amyloidosis.
He received carfilzomib/cyclophosphamide/dexamethasone from 2019-2022. Due to poor MM control, he received high-dose hyperfractionated cyclophosphamide-based therapy with improvement in the lamda light chains (LLC). He was switched to Tec after FDA approval in December 2022. Despite a rapid improvement in his LLCs, his renal function declined and he started dialysis in 2023. After 18 cycles, Tec was stopped in May 2024 due to undetectable light chains. Bone marrow biopsy in April 2025 confirmed a minimal residual disease negative complete response. He remained off therapy with monthly IVIG for hypogammaglobulinemia. In August 2025, he underwent a living-related kidney transplantation with basiliximab induction and tacrolimus, mycophenolate, and prednisone maintenance. Post-transplant course included rhinovirus infection, low level BK viremia, Citrobacter UTI, and mycophenolate intolerance for which he was switched to azathioprine. 6 month surveillance biopsy showed no rejection, BKV or MM recurrence and his serum creatinine is 1.3 mg/dL at 8 months post-transplant. He remains off plasma cell directed therapy and MM markers show sustained remission.
Discussion
For patients with relapsing MM with ESRD being considered for a kidney transplant, newer therapies such as CART and bispecific antibodies allow patients to achieve hematologic remission. Deep and durable remission can be achieved even in patients experiencing multiple relapses. Transplant centers should consider the improved outcomes of patients with ESRD from MM achieving complete response with these newer agents. Multidisciplinary discussions are required for candidacy discussions and post-transplant management.