Long-Term Follow-Up of Patients with Monoclonal Gammopathy of Undetermined Significance after Kidney Transplantation
ABSTRACT Long-term data regarding kidney transplantation (KTx) patients with monoclonal gammopathy of undetermined significance (MGUS) are scarce. We evaluated the long-term outcomes of these patients in a single-center retrospective study from the Mayo Clinic, Rochester, Minn., USA.
Patients who had an MGUS before transplant or developed one after KTx were selected. Monoclonal protein was screened as part of the KTx evaluation by serum protein electrophoresis. Screening for posttransplant lymphoproliferative disorder (PTLD) or MGUS after transplant was not required by protocol. Patients with multiple myeloma, dysproteinemia-related kidney disease or no pretransplant serum protein electrophoresis were excluded.
Between 1963 and 2006, 3,518 patients underwent KTx. MGUS was identified in 42 patients, with 23 before transplant and 19 after transplant. Median follow-up for these patients was 8.5 years (range 0.3-37). Four (17.4%) pretransplant MGUS patients developed a hematologic malignancy: 2 smoldering multiple myeloma and 2 PTLD - an Epstein-Barr virus-positive diffuse large cell lymphoma and a Hodgkin lymphoma. None of the 19 patients who developed an MGUS after transplant progressed to multiple myeloma, but 2 (10.5%) developed Epstein-Barr virus-negative T cell lymphoproliferative disorders at 16 and 26 years after transplant. Median survival was 26.1 and 28.0 years for the pretransplant and posttransplant MGUS groups, respectively.
Progression from true MGUS to multiple myeloma is rare after KTx. KTx appears safe in true MGUS patients if the monoclonal gammopathy was not the cause of the kidney disease. None of the patients progressed to multiple myeloma, but 2 developed smoldering multiple myeloma and several developed PTLD. Further studies are needed to explain the relationship between MGUS and PTLD.
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ABSTRACT: MG is a common event of hematologic malignancies. There are many papers regarding kidney transplantation patients with MGUS in adults, while data in pediatrics are scarce. The etiology and clinical significance of MGUS are unclear both in adults and children. Immunosuppressive drugs, graft antigenicity, and viral infection could play a possible role. The viruses most frequently implicated seem to be EBV or CMV in particular, but their role has to be defined better. However, many investigators have emphasized an impaired balance between an adequate immune response and reactivation of viral infection.Pediatric Transplantation 02/2014; 18(1):42-6. DOI:10.1111/petr.12189 · 1.63 Impact Factor
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ABSTRACT: Proteinuria is an expected complication in transplant patients treated with mammalian target of rapamycin inhibitors (mTOR-i). However, clinical suspicion should always be supported by histological evidence in order to investigate potential alternate diagnoses such as acute or chronic rejection, interstitial fibrosis and tubular atrophy, or recurrent or de novo glomerulopathy. In this case we report the unexpected diagnosis of amyloidosis in a renal-transplant patient with pre-transplant monoclonal gammapathy of undetermined significance who developed proteinuria after conversion from tacrolimus to everolimus.Clinical nephrology 09/2013; 82 (2014)(12). DOI:10.5414/CN107913 · 1.23 Impact Factor
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ABSTRACT: Background Data regarding multiple myeloma (MM) that develops after kidney transplantation (KTx) are scarce. The outcomes of these patients were evaluated in a retrospective study.Methods Patients with newly diagnosed MM after KTx were selected. Patients with a diagnosis of MM, or those who received treatment for monoclonal gammopathy of renal significance (MGRS) prior to KTx were excluded.ResultsBetween 2001 and 2012, 7 patients developed MM after KTx. Reasons for ESRD included: ADPKD (1), C1q nephropathy (1), MPGN (2), hypertensive nephrosclerosis (2) and chronic interstitial nephritis (1). Before KTx, only 4 patients had monoclonal protein studies, 4 had MGUS, and 2 of them had clonal plasma cells in bone marrow. Median follow up after MM was 70 months (range 19-100). Median survival was 80 months. Median time from KTx to MM was 72 months (range 3-204 months). The Kidney allograft failed in 4 patients due to monoclonal protein related renal disease. Five patients received chemotherapy: Bortezomib (n=3), Lenalidomide (n=2), Melphalan (n=1), Thalidomide (n=1), Pomalidomide (n=1), and high dose Dexamethasone (n=1). Three patients received ASCT.ConclusionMM after KTx is rare. Most patients who develop MM had MGUS prior to KTx. There is significant renal involvement in these patients. Survival is not worse when compared to MM without KTx. Further work is needed to identify the best treatment options for these patients.This article is protected by copyright. All rights reserved.Clinical Transplantation 11/2014; 29(1). DOI:10.1111/ctr.12482 · 1.49 Impact Factor