Can individuals on dialysis consider transplant as an option?

Can individuals on dialysis consider transplant as an option?

It is very common to have kidney issues. The majority aren't on dialysis, but it's definitely something that can be caused by the myeloma derived proteins and light chains. So, for example, those light chains made by the myeloma cells can deposit in the kidneys. They can cause light chain cast nephropathy, they can form amyloid deposits, they can cause light chain deposition disease. There's several mechanisms where myeloma can cause kidney failure. And also these patients are typically in their sixties and have hypertension, diabetes, all kinds of other reasons for chronic kidney disease at baseline. And so then this might tip them over the edge and cause them to end up needing dialysis. And if we catch that early enough and get them on treatment quickly, roughly a quarter of these patients at least might be able to come off dialysis with effective treatment of the myeloma. But certainly the longer they've been on dialysis or the longer it's been, the less likely we will be able to get them off dialysis.

Can patients on dialysis go through a stem cell transplant?

Yes, they can. We do it routinely, especially if they're going through transplant for multiple myeloma, which involves just high dose of Mephalan chemotherapy. What we typically do is we'll reduce the dose and we'll split it over two days and minimize the toxicity that way. So that way those patients that are on dialysis can safely go through the stem cell transplant. It may be different for other diseases where they have different induction regimens that may be more difficult. For example, for lymphoma patients on dialysis that have a different conditioning regimen. But for myeloma, we routinely do it and it's very feasible. So what we typically do is we'll have them get their dialysis before they come in. They'll get the two days of Melphalan and after the dialysis, and then the next day, they'll have their next dialysis in the hospital or, in the outpatient. So the day after the chemo, once it's already out of their system anyway, there's probably not a lot of removal of Melphalan in with dialysis anyway. But just to be on the safe side, we typically separate it and then we give them a day of rest, a couple of days of rest to make sure it's all out of their system. And then the next dialysis isn't usually early in the morning, followed by the stem cell infusion. After all, the toxins are cleaned out of their blood at that point. If I do a lot of patient on dialysis, I actually have a lot of experience on dialysis here at Duke. I offer the dual approach where a patient on dialysis have difficulty with the myeloma because they are no candidate for clinical trials. They have less options. So I do the autologous transplant and then I actually do the kidney transplant. I collaborate with the renal transplant team and I send them for a kidney transplant with a lot of success stories, I have to say. So we offer that approach for patients on dialysis.