Successful kidney transplantation in a patient with pre-existing chronic myeloid leukemia treated with imatinib |
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Authors: | Ursula Thiem Veronika Buxhofer-Ausch Wolfgang Kranewitter Gerald Webersinke Wolfgang Enkner Daniel Cejka |
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Institution: | 1. Department of Nephrology and Hypertension Diseases, Transplantation Medicine and Rheumatology, Ordensklinikum Linz, Krankenhaus Elisabethinen, Linz, Austria;2. Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Krankenhaus Elisabethinen, Linz, Austria;3. Laboratory for Molecular Biology and Tumor Cytogenetics, Department of Internal Medicine I, Ordensklinikum Linz, Barmherzige Schwestern, Linz, Austria |
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Abstract: | Active malignancy is an absolute contraindication to kidney transplantation. As for chronic myeloid leukemia (CML), a Philadelphia chromosome-positive myeloproliferative neoplasm, the introduction of tyrosine kinase inhibitors has transformed CML from a lethal into a manageable chronic disease with a close-to-normal life expectancy. To date it is unknown whether kidney transplantation can be safely performed in patients with pre-existing CML. We describe the clinical course of a 57-year-old male patient with chronic kidney disease caused by reflux nephropathy. This patient had undergone first kidney transplantation 20 years earlier and had again been on chronic hemodialysis for 6 years when CML was diagnosed. First-line therapy with 400 mg imatinib daily was well tolerated and induced an optimal cytogenetic and molecular response 3 months after initiation. One and a half years after CML diagnosis, a second kidney transplantation from a deceased donor was performed. Immunosuppression included basiliximab, tacrolimus, mycophenolate mofetil, and corticosteroids. Currently, 2 years posttransplant, renal allograft function is stable (serum creatinine 1.09 mg/dL, estimated glomerular filtration rate 75 mL/min per 1.73 m2), and CML remains in deep molecular remission with imatinib. Imatinib-treated CML in deep molecular remission could be regarded as inactive malignancy and may therefore not be viewed as an absolute contraindication to kidney transplantation. |
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Keywords: | cancer/malignancy/neoplasia: hematogenous/leukemia/lymphoma clinical decision-making clinical research/practice hematology/oncology kidney disease kidney transplantation/nephrology retransplantation |
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