SP797RESULTS OF STEM CELL AND RENAL TRANSPLANTATION IN PATIENTS WITH END STAGE RENAL DISEASE AFTER PLASMA CELL DYSCRASIA

Abstract

Introduction: Plasma cell dyscrasias (PCD) are a cause of end stage renal disease (ESRD). Traditionally, renal transplantation (RT) has been avoided in these patients due to the poor patient survival, the risk of recurrence in RT and the high incidence of life threatening infections. However, the good results of stem cell transplantation (SCT) in combination with the new drugs in PCD patients with ESRD have encouraged to considerer in them a RT. Objetive: To describe the results of our experience of combined therapy with SCT and RT in patients with PCD and ESRD. Matherial and methods: We performed a retrospective study that included all patients with PCD who have received both SCT and RT in our hospital. We reviewed renal, haematological, infection evolution and recipient survival after 3y of follow-up. Results: We included 6 patients: 4 (67%) males, median age 55y(49-57). The causes of ESRD were: 2 cast myeloma, 2 light-chain diseases, 1 primary amyloidosis and 1 focal segmental glomerulosclerosis. The causes of PCD were: 5 multiple myeloma and 1 primary amyloidosis. 4 (67%) of the patients received SCT 4 before RT and 2 (33%) after RT. Immunosuppression was steroids, tacrolimus and mycophenolate. 5 received induction therapy: 4 basiliximab and 1 timoglobuline. The median creatinine at 1 and 3 year was 1.6 (1.1-1.9) and 1.3 (1.1-1.9) mg/dl. One patient developed an acute rejection in 10 month after RT. Renal graft survival non-death censored was 83 %. 5 episodes of infections that need admission occurred in 3 patients: 2 Aspergillus, 2 viral infections and 1 urinary infection. 3 patients developed a recurrence of their PCD after RT: 2 of them had a remission after treatment with lenalidomide (one partial and the other one complete remission) and the other patient died after 15 months. Patient survival was 83% (5 out of 6). Conclusion: Sequential SCT and RT could be a suitable option for patients with PCD and ESRD. The patient and renal graft survival arte conditioned to the relapse of hematological disease and infections complications. The high incidence of fungal infection will require special prophylaxis measure. These results highlight the importance of declaring more number of patients in this situation and with longer follow-up to elucidate the best management of PCD with ESRD.