Living donor kidney and autologous stem cell transplantation for primary systemic amyloidosis (AL) with predominant renal involvement

Nelson Leung, Matthew D. Griffin, Angela Dispenzieri, Eric N. Haugen, James M. Gloor, Thomas R. Schwab, Stephen C Textor, Martha Lacy, Mark R Litzow, Fernando G Cosio, Timothy S. Larson, Morie Gertz, Mark D Stegall

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Primary systemic amyloidosis (AL) is characterized by multiorgan deposition of monoclonal immunoglobulin light chain. Renal involvement is common and impaired kidney function is associated with reduced median survival. Autologous stem cell transplantation (SCT) for AL achieves superior response rates compared to chemotherapy alone but patients with end-stage renal disease (ESRD) may be excluded from consideration. A treatment approach consisting of living donor kidney transplantation (LDKTx) followed by autologous SCT was developed for AL with ESRD. Eight patients underwent LDKTx with immediate graft function. Two suffered unanticipated complications post-KTx and died 10 and 3 months later. Two cases of subclinical acute cellular rejection (ACR) and one case of clinical ACR occurred-all reversible with corticesteroid. Six patients had successful stem cell harvests performed and five of these underwent SCT with satisfactory trilineage engraftment. Renal function remained stable following SCT in four and was reduced in one due to infectious and bleeding complications. One patient, who has thus far elected not to undergo SCT, has proteinuria and histologic evidence of recurrent renal amyloidosis. This experience supports the feasibility of sequential living donor KTx and autologous SCT for carefully selected patients with ESRD due to AL.

Original languageEnglish (US)
Pages (from-to)1660-1670
Number of pages11
JournalAmerican Journal of Transplantation
Volume5
Issue number7
DOIs
StatePublished - Jul 2005

Fingerprint

Living Donors
Stem Cell Transplantation
Amyloidosis
Kidney
Chronic Kidney Failure
Immunoglobulin Light Chains
Proteinuria
Kidney Transplantation
Primary amyloidosis
Stem Cells
Hemorrhage
Transplants
Drug Therapy
Survival

Keywords

  • AL amyloidosis
  • End stage renal disease
  • Kidney transplantation
  • Stem cell transplantation
  • Therapy

ASJC Scopus subject areas

  • Immunology

Cite this

Living donor kidney and autologous stem cell transplantation for primary systemic amyloidosis (AL) with predominant renal involvement. / Leung, Nelson; Griffin, Matthew D.; Dispenzieri, Angela; Haugen, Eric N.; Gloor, James M.; Schwab, Thomas R.; Textor, Stephen C; Lacy, Martha; Litzow, Mark R; Cosio, Fernando G; Larson, Timothy S.; Gertz, Morie; Stegall, Mark D.

In: American Journal of Transplantation, Vol. 5, No. 7, 07.2005, p. 1660-1670.

Research output: Contribution to journalArticle

@article{7b9887d1e0ca48fba3d6b889087dee78,
title = "Living donor kidney and autologous stem cell transplantation for primary systemic amyloidosis (AL) with predominant renal involvement",
abstract = "Primary systemic amyloidosis (AL) is characterized by multiorgan deposition of monoclonal immunoglobulin light chain. Renal involvement is common and impaired kidney function is associated with reduced median survival. Autologous stem cell transplantation (SCT) for AL achieves superior response rates compared to chemotherapy alone but patients with end-stage renal disease (ESRD) may be excluded from consideration. A treatment approach consisting of living donor kidney transplantation (LDKTx) followed by autologous SCT was developed for AL with ESRD. Eight patients underwent LDKTx with immediate graft function. Two suffered unanticipated complications post-KTx and died 10 and 3 months later. Two cases of subclinical acute cellular rejection (ACR) and one case of clinical ACR occurred-all reversible with corticesteroid. Six patients had successful stem cell harvests performed and five of these underwent SCT with satisfactory trilineage engraftment. Renal function remained stable following SCT in four and was reduced in one due to infectious and bleeding complications. One patient, who has thus far elected not to undergo SCT, has proteinuria and histologic evidence of recurrent renal amyloidosis. This experience supports the feasibility of sequential living donor KTx and autologous SCT for carefully selected patients with ESRD due to AL.",
keywords = "AL amyloidosis, End stage renal disease, Kidney transplantation, Stem cell transplantation, Therapy",
author = "Nelson Leung and Griffin, {Matthew D.} and Angela Dispenzieri and Haugen, {Eric N.} and Gloor, {James M.} and Schwab, {Thomas R.} and Textor, {Stephen C} and Martha Lacy and Litzow, {Mark R} and Cosio, {Fernando G} and Larson, {Timothy S.} and Morie Gertz and Stegall, {Mark D}",
year = "2005",
month = "7",
doi = "10.1111/j.1600-6143.2005.00920.x",
language = "English (US)",
volume = "5",
pages = "1660--1670",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - Living donor kidney and autologous stem cell transplantation for primary systemic amyloidosis (AL) with predominant renal involvement

AU - Leung, Nelson

AU - Griffin, Matthew D.

AU - Dispenzieri, Angela

AU - Haugen, Eric N.

AU - Gloor, James M.

AU - Schwab, Thomas R.

AU - Textor, Stephen C

AU - Lacy, Martha

AU - Litzow, Mark R

AU - Cosio, Fernando G

AU - Larson, Timothy S.

AU - Gertz, Morie

AU - Stegall, Mark D

PY - 2005/7

Y1 - 2005/7

N2 - Primary systemic amyloidosis (AL) is characterized by multiorgan deposition of monoclonal immunoglobulin light chain. Renal involvement is common and impaired kidney function is associated with reduced median survival. Autologous stem cell transplantation (SCT) for AL achieves superior response rates compared to chemotherapy alone but patients with end-stage renal disease (ESRD) may be excluded from consideration. A treatment approach consisting of living donor kidney transplantation (LDKTx) followed by autologous SCT was developed for AL with ESRD. Eight patients underwent LDKTx with immediate graft function. Two suffered unanticipated complications post-KTx and died 10 and 3 months later. Two cases of subclinical acute cellular rejection (ACR) and one case of clinical ACR occurred-all reversible with corticesteroid. Six patients had successful stem cell harvests performed and five of these underwent SCT with satisfactory trilineage engraftment. Renal function remained stable following SCT in four and was reduced in one due to infectious and bleeding complications. One patient, who has thus far elected not to undergo SCT, has proteinuria and histologic evidence of recurrent renal amyloidosis. This experience supports the feasibility of sequential living donor KTx and autologous SCT for carefully selected patients with ESRD due to AL.

AB - Primary systemic amyloidosis (AL) is characterized by multiorgan deposition of monoclonal immunoglobulin light chain. Renal involvement is common and impaired kidney function is associated with reduced median survival. Autologous stem cell transplantation (SCT) for AL achieves superior response rates compared to chemotherapy alone but patients with end-stage renal disease (ESRD) may be excluded from consideration. A treatment approach consisting of living donor kidney transplantation (LDKTx) followed by autologous SCT was developed for AL with ESRD. Eight patients underwent LDKTx with immediate graft function. Two suffered unanticipated complications post-KTx and died 10 and 3 months later. Two cases of subclinical acute cellular rejection (ACR) and one case of clinical ACR occurred-all reversible with corticesteroid. Six patients had successful stem cell harvests performed and five of these underwent SCT with satisfactory trilineage engraftment. Renal function remained stable following SCT in four and was reduced in one due to infectious and bleeding complications. One patient, who has thus far elected not to undergo SCT, has proteinuria and histologic evidence of recurrent renal amyloidosis. This experience supports the feasibility of sequential living donor KTx and autologous SCT for carefully selected patients with ESRD due to AL.

KW - AL amyloidosis

KW - End stage renal disease

KW - Kidney transplantation

KW - Stem cell transplantation

KW - Therapy

UR - http://www.scopus.com/inward/record.url?scp=21344444840&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=21344444840&partnerID=8YFLogxK

U2 - 10.1111/j.1600-6143.2005.00920.x

DO - 10.1111/j.1600-6143.2005.00920.x

M3 - Article

C2 - 15943624

AN - SCOPUS:21344444840

VL - 5

SP - 1660

EP - 1670

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 7

ER -