Can individuals on dialysis consider ASCT?

Can individuals on dialysis consider autologous stem cell transplant or a kidney transplant? So one of the things we often think about for patients who are on dialysis is whether transplantation is appropriate for them. When I'm talking about transplantation at this point in time, I'm thinking about stem cell transplantation rather than kidney transplantation, okay? Because kidney transplantation may also be appropriate, but we'll think about the myeloma first. And yes, so many centres now do do autologous transplants for patients who are on dialysis. It does depend a little bit on insurance because not all insurances will cover it. And it also depends a little bit on how frequent the dialysis is. However, if the patient is fit and meets all of the other criteria to be well enough to have a transplant, then the data suggests that it's actually very useful. We do tend to do the transplant a little bit differently though in the fact that when we give the chemotherapy associated for the transplant, in somebody who has normal kidneys, they metabolise the drug very well. In somebody who has kidneys that are slightly damaged, they don't metabolise the drug so well so we give a lower dose of the chemotherapy. And then we also clearly need to time the dialysis around when we're giving the chemotherapy so that we leave the drug in long enough to work, but not too long to cause any damage. But yes, definitely possible. Can a person on dialysis receive a kidney transplant? So years ago, the thought process about a kidney transplant for a myeloma patient was that it wasn't appropriate. However, at that time, it was because we didn't really have very good treatments for myeloma. And obviously, a kidney is a precious resource, particularly one that's being donated. And so it was felt that maybe somebody else might benefit from it more. But there's been a change in the way myeloma is treated and in what we can expect for myeloma patients. And so often now, if patients have had a good response to their myeloma therapy, then they will often be considered for having a transplant. And we've had some really great responses and it can make a dramatic difference to quality of life.