Patients with multiple myeloma (MM) who developed end-stage renal disease (ESRD) are generally not eligible for either kidney transplantation or allogeneic stem-cell transplant. We performed combined kidney and bone marrow transplantation (CKBMT) in 13 patients with ESRD secondary to MM from either HLA identical (n=10) or haploidentical (n=3) donors. [Method]The conditioning for HLA identical CKBMT included Cyclophosphamide (Cy), ATG, thymic irradiation and cyclosporine. The initial regimen for HLA haploidentical CKBMT included Cy, ATG and 200 cGy of total body irradiation. After CKBMT, Cy (50mg/kg) was administered on days 3 and 4, followed by tacrolimus and MMF. The regimen was subsequently revised by replacing ATG with fludarabine. [Results] 12/13 recipients achieved normal or near normal kidney function without rejection throughout the post-transplant course. Immunosuppression was successfully withdrawn in 5/10 recipients of HLA identical and one recipient of haploidentical CKBMT. Three HLA identical recipients developed persistent full or mixed chimerism and survived for 3-12 years. Among five HLA identical recipients who developed transient chimerism, two underwent a 2nd BMT and achieved a complete remission (CR) for 1 -11+ years and three patients survived for 7-17+ years. Of three HLA haploidnetical CKBMT recipients, two developed persistent full donor chimerism without GVHD and achieved a CR. One recipient developed only transient chimerism but achieved an ongoing CR for >2.7 years.

[Conclusion] Our strategy of CKBMT offers an opportunity for kidney and bone marrow transplantation for patients with MM and ESRD.

CITATION INFORMATION: Kawai T, Chen Y.-B, Sykes M, Benedict C, Tolkoff-Rubin N, Day B, McAfee S, Ballen K, David S, Spitzer T. HLA Identical or Haploidentical Combined Kidney and Bone Marrow Transplantation for Multiple Myeloma with End-Stage Renal Failure. Am J Transplant. 2016;16 (suppl 3).

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