Advances in Kidney Transplantation Following Multiple Myeloma

As a result of advances in treatment for multiple myeloma in patients with end-stage renal disease (ESRD), individuals in that patient population are increasingly being offered kidney transplantation. There are few data available on the risks and benefits of kidney transplantation in patients with multiple myeloma and ESRD.

V.Nair and colleagues at Northwell Health, Manhasset, New York, conducted an analysis of all reported cases in the last 19 years of patients with multiple myeloma who underwent kidney transplantation to identify the hematologic and transplant outcomes. Results of the analysis were reported during a virtual poster session at the American Transplant Congress 2020 in a poster titled Kidney Transplantation after Multiple Myeloma: The Last 2 Decades.

The researchers reviewed all publications from January 2000 to November 2019 that included patients with multiple myeloma who underwent kidney transplantation. The analysis was designed to evaluate variables and outcomes in that patient population including demographics, cause of ESRD, treatment for multiple myeloma, episodes of relapse, time to relapse, de novo malignancies, graft loss, and death.

The search identified ten publications and data on 36 patients. The majority (22/36) were published in 2019. Time from multiple myeloma treatment to kidney transplantation was shorter for patients for relapsed/progressed than for those who did not (34 months versus 51 months); the difference was not statistically significant.

The mean duration  between multiple myeloma treatment and kidney transplantation was shorter in patients who died compared with patients who survived (39 months vs 57 months). The adjusted mean waiting time between treatment and transplantation was not a significant predictor for relapse/progression, death, or graft loss, and there was no impact of the type of multiple myeloma therapy on relapse. The only factor found to reduce the odds of relapse was increased age (odds ratio, 0.88; P=.021).

“Reports of kidney transplantation in patients with multiple myeloma are increasing. Our data help coalesce patient data over the last 20 years and can help inform clinicians and patients on expected hematologic and transplant outcomes in the complex population. Based on our analysis, only age influenced the risk of multiple myeloma relapse, although time from multiple myeloma treatment to kidney transplantation was numerically shorter in patients with relapse or death,” the researchers said.

Source: Nair V, Jhaveri K, Abate M. Kidney transplantation after multiple myeloma: The last 2 decades. Abstract of a poster presented at the virtual American Transplant Congress 2020 (Abstract B-207), May 30, 2020.