Patients with myeloma may benefit from bortezomib treatment prior to kidney transplant
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A small single-center study published in Kidney International Reports suggests giving bortezomib treatment to patients with multiple myeloma prior to a kidney transplantation to ensure best outcomes.
However, it is still common for patients with multiple myeloma to relapse after kidney transplantation with the treatment.
“Despite treatment with novel agents, a considerable number of patients with multiple myeloma still develop end-stage kidney disease. Long-term dialysis for myeloma patients has significant mortality risk and may prevent them from clinical trials for multiple myeloma treatment, as well as significantly impacting their quality of life,” Nelson Leung, MD, from the division of nephrology and hypertension at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “Thus, we hypothesize that kidney transplantation in selected cases can improve the quality of life and may increase the overall survival of selected patients with multiple myeloma without significant harm.”
Researchers evaluated 11 patients (median age was 64; seven were women). All patients had multiple myeloma and a kidney transplantation surgery at Rochester Mayo Clinic between 1994 and 2019. Novel agents given to patients included bortezomib, carfilzomib, ixazomib, lenalidomide, pomalidomide and daratumumab.
Median follow-up after kidney transplantation was 40 months, and researchers performed allograft biopsies at implantation and at 4 months, 1 year, 2 years, 5 years and 10 years after transplantation.
Using Cox-regression analysis, researchers assessed the effects of the time from the last hematologic response to kidney transplantation on overall survival, graft survival and progression-free survival.
Researchers measured overall survival from time of transplant to death from any cause or until the patient’s final visit.
Twelve transplants occurred in the 11 patients during the study period. Among the patients, six had a stringent complete response, two had a complete response, two had a very good partial response and two had a partial response.
At the median follow-up, 75% of patients showed signs of hematologic progression. Three grafts failed, and five patients died despite functioning allografts. Overall survival was higher for patients who received bortezomib. At 1-, 3-, and 5-year follow-ups, those treated with bortezomib showed 87.5%, 72.9% and 72.9% overall survival, respectively, compared with those treated without it at 66.7%, 33.3% and 33.3%, respectively.
“While this is a small single-center study, this is the largest study of symptomatic myeloma patients with kidney transplant to date,” Leung and colleagues wrote. “One of the major findings of our study is that myeloma patients who received bortezomib at any time did better than those who was never treated with bortezomib. Another is the lack of benefit of longer waiting time, unlike in solid cancers. Both of these findings will need to be confirmed.”
The researchers added, “While kidney transplantation cannot be recommended for all patients with multiple myeloma who develop ESKD, our study suggests that long-term allograft and patient survival can be achieved and will likely improve as more effective therapies for myeloma develop.”
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