Abstract: TH-PO1053
Recurrent Acute Myeloid Leukemia Early After Kidney Transplantation
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Son, Jae Hun, Emory University School of Medicine, Atlanta, Georgia, United States
- Basu, Arpita, Emory University School of Medicine, Atlanta, Georgia, United States
Introduction
Acute myeloid leukemia (AML) accounts for 2% of cancer-related deaths. Outcomes after relapse following allogeneic hematopoietic stem cell transplantation (allo-HSCT) are poor. Insufficient data exists on the prognosis in solid organ transplant recipients with AML who relapse after allo-HSCT but sustain remission beyond 5 years.
Case Description
A 59-year-old man with ESRD secondary to diabetes was diagnosed with AML in 2016. Cytogenetics showed a normal female donor karyotype; FISH panel for trisomy 8, deletion 7q, and monosomy 7 were negative. He underwent allo-HSCT but relapsed 1.5 years later, was treated with chemotherapy, and achieved complete remission by June 2019. He was cleared by oncology for kidney transplantation (KTX).
He received a deceased donor KTX in June 2025 with basiliximab induction and maintenance with tacrolimus, mycophenolate mofetil, and prednisone. His creatinine stabilized at 1.3–1.7 mg/dL.
At 4 months, he developed progressive lower extremity weakness and was hospitalized at 6 months for pedal edema, managed with diuresis, then discharged to subacute rehab. One month later, he was readmitted with lower extremity sensory and motor deficits, urinary retention, and fecal incontinence. MRI spine demonstrated diffusely thickened and enhancing cauda equina roots with leptomeningeal enhancement along the lower thoracic cord and conus. Lumbar puncture confirmed isolated leptomeningeal (CNS) AML relapse. His renal allograft function remains excellent.
Discussion
We present a rare case of AML relapse with CNS involvement early post-KTX despite prolonged remission following HSCT. Approximately 68% of relapses occur within the first year after allogeneic HSCT. Late relapse beyond 2 years is rare, occurring in only 4.2%, with 2-year overall survival of only 44%. The optimal surveillance duration following post-HSCT relapse and remission prior to KTX remains unclear, potentially limiting transplant access.
AML relapse after HSCT carries a poor prognosis and no clear guidelines exist for KTX candidacy. Registry data for similar rare cohorts are needed to better understand post-KTX outcomes.