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Table of Contents
Vol. 35, No. 4, 2012
Issue release date: May 2012
Am J Nephrol 2012;35:365–371
(DOI:10.1159/000337482)

Long-Term Follow-Up of Patients with Monoclonal Gammopathy of Undetermined Significance after Kidney Transplantation

Naina H.V.K. · Harris S. · Dispenzieri A. · Cosio F.G. · Habermann T.M. · Stegall M.D. · Dean P.G. · Prieto M. · Kyle R.A. · Rajkumar S.V. · Leung N.
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Abstract

Introduction: Long-term data regarding kidney transplantation (KTx) patients with monoclonal gammopathy of undetermined significance (MGUS) are scarce. We evaluated the long-term outcomes of these patients in a single-center retrospective study from the Mayo Clinic, Rochester, Minn., USA. Methods: Patients who had an MGUS before transplant or developed one after KTx were selected. Monoclonal protein was screened as part of the KTx evaluation by serum protein electrophoresis. Screening for posttransplant lymphoproliferative disorder (PTLD) or MGUS after transplant was not required by protocol. Patients with multiple myeloma, dysproteinemia-related kidney disease or no pretransplant serum protein electrophoresis were excluded. Results: Between 1963 and 2006, 3,518 patients underwent KTx. MGUS was identified in 42 patients, with 23 before transplant and 19 after transplant. Median follow-up for these patients was 8.5 years (range 0.3–37). Four (17.4%) pretransplant MGUS patients developed a hematologic malignancy: 2 smoldering multiple myeloma and 2 PTLD – an Epstein-Barr virus-positive diffuse large cell lymphoma and a Hodgkin lymphoma. None of the 19 patients who developed an MGUS after transplant progressed to multiple myeloma, but 2 (10.5%) developed Epstein-Barr virus-negative T cell lymphoproliferative disorders at 16 and 26 years after transplant. Median survival was 26.1 and 28.0 years for the pretransplant and posttransplant MGUS groups, respectively. Conclusion: Progression from true MGUS to multiple myeloma is rare after KTx. KTx appears safe in true MGUS patients if the monoclonal gammopathy was not the cause of the kidney disease. None of the patients progressed to multiple myeloma, but 2 developed smoldering multiple myeloma and several developed PTLD. Further studies are needed to explain the relationship between MGUS and PTLD.



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References

  1. Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Offord JR, Dispenzieri A, Katzmann JA, Melton LJ 3rd: Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med 2006;354:1362–1369.
  2. Leung N, Lager DJ, Gertz MA, Wilson K, Kanakiriya S, Fervenza FC: Long-term outcome of renal transplantation in light-chain deposition disease. Am J Kidney Dis 2004;43:147–153.
  3. Blade J, Dimopoulos M, Rosinol L, Rajkumar SV, Kyle RA: Smoldering (asymptomatic) multiple myeloma: current diagnostic criteria, new predictors of outcome, and follow-up recommendations. J Clin Oncol 2010;28:690–697.
  4. Kyle RA, Remstein ED, Therneau TM, Dispenzieri A, Kurtin PJ, Hodnefield JM, Larson DR, Plevak MF, Jelinek DF, Fonseca R, Melton LJ 3rd, Rajkumar SV: Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma. N Engl J Med 2007;356:2582–2590.
  5. Kyle RA, Durie BG, Rajkumar SV, Landgren O, Blade J, Merlini G, Kroger N, Einsele H, Vesole DH, Dimopoulos M, San Miguel J, Avet-Loiseau H, Hajek R, Chen WM, Anderson KC, Ludwig H, Sonneveld P, Pavlovsky S, Palumbo A, Richardson PG, Barlogie B, Greipp P, Vescio R, Turesson I, Westin J, Boccadoro M: Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia 2010;24:1121–1127.
  6. Rajkumar SV, Larson D, Kyle RA: Diagnosis of smoldering multiple myeloma. N Engl J Med 2011;365:474–475.
  7. Rostaing L, Modesto A, Abbal M, Durand D: Long-term follow-up of monoclonal gammopathy of undetermined significance in transplant patients. Am J Nephrol 1994;14:187–191.
  8. Badley AD, Portela DF, Patel R, Kyle RA, Habermann TM, Strickler JG, Ilstrup DM, Wiesner RH, de Groen P, Walker RC, Paya CV: Development of monoclonal gammopathy precedes the development of Epstein-Barr virus-induced posttransplant lymphoproliferative disorder. Liver Transpl Surg 1996;2:375–382.
  9. Czarnecki PG, Lager DJ, Leung N, Dispenzieri A, Cosio FG, Fervenza FC: Long-term outcome of kidney transplantation in patients with fibrillary glomerulonephritis or monoclonal gammopathy with fibrillary deposits. Kidney Int 2009;75:420–427.

    External Resources

  10. Lorenz EC, Sethi S, Leung N, Dispenzieri A, Fervenza FC, Cosio FG: Recurrent membranoproliferative glomerulonephritis after kidney transplantation. Kidney Int 2010;77:721–728.

    External Resources

  11. Swerdlow SH CE, Harris NL, et al. (ed): Post-transplant lymphoproliferative disorders; in WHO Classification of Tumours of Hematopoietic and Lymphoid Tissues. Lyon, IARC Press, 2008, pp 343–349.
  12. Fogo A, Qureshi N, Horn RG: Morphologic and clinical features of fibrillary glomerulonephritis versus immunotactoid glomerulopathy. Am J Kidney Dis 1993;22:367–377.
  13. Radl J, Valentijn RM, Haaijman JJ, Paul LC: Monoclonal gammapathies in patients undergoing immunosuppressive treatment after renal transplantation. Clin Immunol Immunopathol 1985;37:98–102.
  14. Passweg J, Thiel G, Bock HA: Monoclonal gammopathy after intense induction immunosuppression in renal transplant patients. Nephrol Dial Transplant 1996;11:2461–2465.
  15. Kyle RA, Therneau TM, Rajkumar SV, Offord JR, Larson DR, Plevak MF, Melton LJ 3rd: A long-term study of prognosis in monoclonal gammopathy of undetermined significance. N Engl J Med 2002;346:564–569.

    External Resources

  16. Rajkumar SV, Kyle RA, Therneau TM, Melton LJ 3rd, Bradwell AR, Clark RJ, Larson DR, Plevak MF, Dispenzieri A, Katzmann JA: Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance. Blood 2005;106:812–817.
  17. Passweg J, Bock HA, Tichelli A, Thiel G: ‘Transient multiple myeloma’ after intense immunosuppression in a renal transplant patient. Nephrol Dial Transplant 1993;8:1393–1394.
  18. Dysseleer A, Michaux L, Cosyns JP, Goffin E, Hermans C, Pirson Y: Benign monoclonal gammopathy turning to al amyloidosis after kidney transplantation. Am J Kidney Dis 1999;34:166–169.
  19. Babel N, Schwarzmann F, Pruss A, Volk HD, Reinke P: Monoclonal gammopathy of undetermined significance (MGUS) is associated with an increased frequency of Epstein-Barr virus (EBV) latently infected B lymphocytes in long-term renal transplant patients. Transplant Proc 2004;36:2679–2682.
  20. Caillard S, Agodoa LY, Bohen EM, Abbott KC: Myeloma, Hodgkin disease, and lymphoid leukemia after renal transplantation: characteristics, risk factors and prognosis. Transplantation 2006;81:888–895.

    External Resources

  21. Nelson BP, Nalesnik MA, Bahler DW, Locker J, Fung JJ, Swerdlow SH: Epstein-Barr virus-negative post-transplant lymphoproliferative disorders: a distinct entity? Am J Surg Pathol 2000;24:375–385.
  22. Gentile TC, Hadlock KG, Uner AH, Delal B, Squiers E, Crowley S, Woodman RC, Foung SK, Poiesz BJ, Loughran TP Jr: Large granular lymphocyte leukaemia occurring after renal transplantation. Br J Haematol 1998;101:507–512.
  23. Caillard S, Dharnidharka V, Agodoa L, Bohen E, Abbott K: Posttransplant lymphoproliferative disorders after renal transplantation in the United States in era of modern immunosuppression. Transplantation 2005;80:1233–1243.
  24. Saadat A, Einollahi B, Ahmadzad-Asl MA, Moradi M, Nafar M, Pourfarziani V, Firoozan A, Porrezagholi F, Davoudi F: Posttransplantation lymphoproliferative disorders in renal transplant recipients: report of over 20 years of experience. Transplant Proc 2007;39:1071–1073.
  25. Soler MJ, Puig JM, Mir M, Parrilla J, Pedro C, Salar A, Serrano S, Lloveras J: Posttransplant lymphoproliferative disease: treatment and outcome in renal transplant recipients. Transplant Proc 2003;35:1709–1713.
  26. Katzmann JA, Kyle RA, Benson J, Larson DR, Snyder MR, Lust JA, Rajkumar SV, Dispenzieri A: Screening panels for detection of monoclonal gammopathies. Clin Chem 2009;55:1517–1522.


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