Bortezomib-based Chemotherapy and Bone-marrow Followed by Renal Transplantation in Multiple Myeloma: A Literature Review

Background:The gold standard for managing young patients with multiple myeloma (MM) involves induction therapy with a 3 or 4 drugs combination followed by consolidation with autologous stem cell transplantation (ASCT).Materials and Methods:This study is case-centric literature review of kidney transplant in MM subsequent to ASCT over the past two decades, notably during the "Bortezomib era" from May 2003 (when Bortezomib was approved by the Food and Drug Administration for treating MM) to December 2022.Results:Seven publications met the inclusion criteria, with 18 patients, including one patient from our institute. The median age of the participants was 56 (range, 30-70) years, and 11/18 (61%) of the participants were male. The median time from ASCT to kidney transplant was 29.5 months (range, 6-166 months). Based on the hematological response before kidney transplantation, 5 patients had a very good partial response, 6 had a complete response (CR), and 5 had a stringent CR. In the period following kidney transplant, five (27.7%) patients developed relapses of myeloma. Three (16.6%) patients experienced allograft rejection. At the last follow-up, 3 patients (16.6%) had graft losses. A total of 15 patients (83.3%) were alive at the end of the follow-up period, 13 of whom had functioning renal allografts. At 1, 3, and 5 years, the overall patient survival rates of this cohort were 87.5%, 75%, and 50%, respectively.Discussion:The present study being the first of its kind to encompass MM patients who have undergone proteasome inhibitor-based chemotherapy, with all participants having undergone ASCT before kidney transplant. Kidney transplantation is crucial for patients with MM due to the lower overall survival of MM patients on dialysis.