Kidney Transplant in a Patient with Multiple Myeloma. Clinical Case
Authors: Ovilla-Martínez Roberto , Martha Alvarado , Dela Peña Celaya Jose Antonio , Ramirez Muniz Nishalle E , Baez Islas Pamela E , Cota Rangel Xochitl 
Published: December 2024

OBJETIVE

To present the result of a patient with multiple myeloma and chronic kidney disease KDIGO 5 with hemodialysis and treatment for multiple myeloma with KRD-Dara undergoing kidney transplant

INTRODUCTION

Multiple myeloma is a hematological neoplasm characterized by the presence of abnormal clonal plasma cells in the bone marrow, with the potential for uncontrolled proliferation, causing lytic bone lesions (79%), kidney injury (19%), anemia (73%) and hypercalcemia.

Kidney transplantation for chronic kidney disease associated with multiple myeloma is rarely considered as an option for renal function replacement therapy, given that to date it is considered an incurable neoplasm, as well as the high risk of subsequent multiple myeloma relapse to transplant

CLINICAL CASE

Multiple myeloma was diagnosed in male 46 years old with an ISS 2. Treatment was started with lenalidomide 5 mg every 24 hours for 21 days, carfilzomib 70 mg/m2, daratumumab 16 mg/kg, continuing for 6 cycles, on days 1, 8, 15 and 22 each. cycle; in addition to erythropoietin beta 150 mcg SC every 2 weeks and dexamethasone 20 mg weekly, (KRD-Dara) subsequently maintenance with lenalidomide 25 mg PO every 24 hours for 21 days and daratumumab monthly.

During the evolution, ischemic event cerebral was diagnosed, presenting aphasia, which was resolved 48 hrs later.He was subsequently hospitalized for bleeding from the digestive system, and a diagnosis of infectious gastroenteritis due to Salmonella spp. Colonoscopy with sessile polyps of 3 mm in the sigmoid colon, 5 mm in the transverse colon, with hyperplastic characteristics. Panendoscopy with erosive gastropathy and non-erosive duodenopathy. At 3 months, detectable minimal residual disease (MRD) of 0.0013% was achieved and a normal polyclonal plasma cell population of 0.0018% was detected, and on november 27, 2020, a negative MRD of 0.000% was obtained.

A year later he presented to the transplant committee, and a kidney transplant was performed from a deceased donor, from a 33-year-old female donor, with blood group AB Rh +, while he had group A Rh +, with a direct negative cross-match test result. alloantibodies.Recipient AB+, 33-year-old female donor, A+, crossmatch negative, direct serum alloantibodies negative, DTT+AHG (dithiothreitol+Anti Human Globulin) alloantibodies negative.HLA class I: A*02, A*02, B*27 , B*40:02, C*02, C*03:02. HLA Class II: DRB1*04, DRB1*04, DQB1*03:02, DQB1*04, DPB1*04:01, DPB1*04:02, DRB4*, DRB4*. Made with DNA by PCR-SSP molecular method.

Prophylaxis against acute rejection begins with thymoglobulin at a dose of 50 mg/day for 5 days, tacrolimus 3 mg every 12 hours, and mycophenolate 500 every 12 hours. And as antimicrobial prophylaxis, valganciclovir and trimethoprim/sulfamethoxazole.

After the transplant, hypogammaglobulinemia persisted, so intravenous immunoglobulin was administered on one occasion.

As Multiple Myeloma Maintenance, he has received Lenalidomide 5 mg daily for 21 days in 28-day cycles to date.

DISCUSSION

Few cases of kidney transplant in patients with multiple myeloma have been reported, with diverse overall survivals, in one of the largest series reported by the Mayo Clinic, with 12 patients, they had a disease-free survival at 1, 3 and 5 years of 83.3%, our patient maintains normal renal function and minimal negative residual disease until now only with maintenance lenalidomide