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HLA Identical or Haploidentical Combined Kidney and Bone Marrow Transplantation for Multiple Myeloma with End-Stage Renal Failure.

T. Kawai,1 Y.-B. Chen,1 M. Sykes,2 C. Benedict,1 N. Tolkoff-Rubin,1 B. Day,1 S. McAfee,1 K. Ballen, S. David,1 T. Spitzer.1

1Massachusetts General Hospital, Boston
2Columbia University, New York.

Meeting: 2016 American Transplant Congress

Abstract number: 187

Keywords: Bone marrow transplantation, Kidney transplantation, Mixed chimerism, Tolerance

Session Information

Date: Monday, June 13, 2016

Session Name: Concurrent Session: Clinical Science: Tolerance: Clinical Studies

Session Time: 2:30pm-4:00pm

 Presentation Time: 3:06pm-3:18pm

Location: Room 304

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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 Immunosuppression was successfully withdrawn in 5/10 recipients of HLA identical and one recipient of haploidentical CKBMT.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.

HLA Chimerism(*after second BMT) Patient/Kidney Survival Immunosuppression
identical transient >17 yrs OFF
identical transient 7 yrs OFF
identical persistent full 12 yrs on for GVHD
identical transient >13 yrs OFF
identical transient –>full* >11.9 yrs on for GVHD
identical persistent full 4 yrs on for GVHD
identical persistent mixed  >9 yrs OFF
identical persistent full 3 yrs on for GVHD
identical persistent full >5 yrs OFF
identical transient –> full* >4.8 yrs on for GVHD
haploidentical  transient >2.7 yrs ON
haploidentical persistent full >2 yrs OFF
haploidentical persistent full >0.5 yrs tapering

[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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To cite this abstract in AMA style:

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. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/hla-identical-or-haploidentical-combined-kidney-and-bone-marrow-transplantation-for-multiple-myeloma-with-end-stage-renal-failure/. Accessed January 21, 2021.

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