Bhavna Bhasin1, Aniko Szabo2, Ruizhe Wu2, Ehab R Saad3, Parameswaran Hari4, Binod Dhakal4, Saurabh Chhabra4, Anita D'Souza4. 1. Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI. Electronic address: bbhasin@mcw.edu. 2. Institute of Health and Society, Medical College of Wisconsin, Milwaukee, WI. 3. Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI. 4. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI.
Abstract
INTRODUCTION: Plasma cell disorders (PCDs) are clonal plasma cell disorders that include conditions such as monoclonal gammopathy of undetermined significance (MGUS), monoclonal gammopathy of renal significance (MGRS), multiple myeloma (MM), smoldering MM (SMM), solitary plasmacytoma, and light-chain (AL) amyloidosis. The risk factors associated with and the clinical course of PCDs after renal transplantation is not well established although immunosuppressive protocols may impact the incidence and natural history of PCDs posttransplant. PATIENTS AND METHODS: This single-center retrospective study evaluated patients with a history of renal transplant who developed a PCD between January 1, 2014-December 31, 2018. RESULT: A total of 41 patients met the inclusion criteria including 29 with MGUS and 12 with symptomatic PCD (4 with MM, 2 with SMM, 4 with MGRS, 1 with AL amyloidosis, and 1 with solitary plasmacytoma). The median follow-up of survivors was 41.6 months. Three patients (1 with MGUS and 2 with MGRS) progressed to MM during the follow-up period. There was a male preponderance in both groups. There was no correlation between the donor and immunosuppressive regimen and the development of a PCD. Patients with symptomatic PCD had higher serum creatinine and M-protein levels at diagnosis and higher free light chain ratio and plasma cell burden. There was also a higher percentage of allograft failure noted in the symptomatic PCD subset 50% (n = 6), whereas only 23% (n = 7) of patients had allograft failure in the MGUS group. CONCLUSION: This study shows the importance of considering monoclonal gammopathy in the differential of renal dysfunction after kidney transplant and the need to follow these patients closely to monitor for progression to symptomatic PCD.
INTRODUCTION: Plasma cell disorders (PCDs) are clonal plasma cell disorders that include conditions such as monoclonal gammopathy of undetermined significance (MGUS), monoclonal gammopathy of renal significance (MGRS), multiple myeloma (MM), smoldering MM (SMM), solitary plasmacytoma, and light-chain (AL) amyloidosis. The risk factors associated with and the clinical course of PCDs after renal transplantation is not well established although immunosuppressive protocols may impact the incidence and natural history of PCDs posttransplant. PATIENTS AND METHODS: This single-center retrospective study evaluated patients with a history of renal transplant who developed a PCD between January 1, 2014-December 31, 2018. RESULT: A total of 41 patients met the inclusion criteria including 29 with MGUS and 12 with symptomatic PCD (4 with MM, 2 with SMM, 4 with MGRS, 1 with AL amyloidosis, and 1 with solitary plasmacytoma). The median follow-up of survivors was 41.6 months. Three patients (1 with MGUS and 2 with MGRS) progressed to MM during the follow-up period. There was a male preponderance in both groups. There was no correlation between the donor and immunosuppressive regimen and the development of a PCD. Patients with symptomatic PCD had higher serum creatinine and M-protein levels at diagnosis and higher free light chain ratio and plasma cell burden. There was also a higher percentage of allograft failure noted in the symptomatic PCD subset 50% (n = 6), whereas only 23% (n = 7) of patients had allograft failure in the MGUS group. CONCLUSION: This study shows the importance of considering monoclonal gammopathy in the differential of renal dysfunction after kidney transplant and the need to follow these patients closely to monitor for progression to symptomatic PCD.
Authors: Harris V K Naina; Samar Harris; Angela Dispenzieri; Fernando G Cosio; Thomas M Habermann; Mark D Stegall; Patrick G Dean; Mikel Prieto; Robert A Kyle; S Vincent Rajkumar; Nelson Leung Journal: Am J Nephrol Date: 2012-04-02 Impact factor: 3.754
Authors: Samih H Nasr; Anthony M Valeri; Sanjeev Sethi; Mary E Fidler; Lynn D Cornell; Morie A Gertz; Martha Lacy; Angela Dispenzieri; S Vincent Rajkumar; Robert A Kyle; Nelson Leung Journal: Am J Kidney Dis Date: 2012-03-13 Impact factor: 8.860
Authors: Nelson Leung; Frank Bridoux; Colin A Hutchison; Samih H Nasr; Paul Cockwell; Jean-Paul Fermand; Angela Dispenzieri; Kevin W Song; Robert A Kyle Journal: Blood Date: 2012-10-09 Impact factor: 22.113