肾移植后复发性多发性骨髓瘤：一例报告。

Recurrent multiple myeloma following renal transplantation: a case report.

作者信息

Taheri D, Chehrei A, Fesharakizadeh M, Seyrafean S, Shahidi S, Emami A, Taheri S, Azani M

机构信息

Department of Pathology, Isfahan university of Medical science, Isfahan, Iran.

出版信息

Transplant Proc. 2007 May;39(4):1063-5. doi: 10.1016/j.transproceed.2007.02.015.

DOI:10.1016/j.transproceed.2007.02.015

PMID:17524892

Abstract

Renal transplantation is generally not considered for patients with multiple myeloma (MM) because of their extremely poor prognosis. However, for patients in remission, it offers an alternative to dialysis. There are few reports of MM recurrence among kidney transplant recipients. We report a 57-year-old white man with end-stage renal disease (ESRD) and known multiple myeloma in remission who underwent kidney transplantation. Eighteen months after transplantation upon routine follow-up, he was observed to have an elevated creatinine with no evidence of recurrence of myeloma upon bone marrow aspiration. Light microscopy and immunofluorescence of a renal biopsy showed chronic scarring of the kidney owing to cast nephropathy consistent with MM recurrence. Repeat bone marrow aspiration 1 week later confirmed this diagnosis. A review of the literature of prior studies suggested that it is reasonable to perform renal transplantation in patients with ESRD due to MM in remission, but large prospective studies would help to develop a strategy for prevention of multiple myeloma recurrence.

摘要

由于预后极差，多发性骨髓瘤（MM）患者一般不考虑进行肾移植。然而，对于处于缓解期的患者，肾移植为透析提供了一种替代方案。肾移植受者中MM复发的报道很少。我们报告了一名57岁的白人男性，患有终末期肾病（ESRD），已知多发性骨髓瘤处于缓解期，接受了肾移植。移植后18个月进行常规随访时，发现他的肌酐升高，骨髓穿刺未发现骨髓瘤复发的迹象。肾活检的光镜和免疫荧光检查显示，由于管型肾病导致肾脏慢性瘢痕形成，符合MM复发。1周后再次进行骨髓穿刺确诊了这一诊断。对既往研究文献的回顾表明，对于因MM处于缓解期而患有ESRD的患者进行肾移植是合理的，但大型前瞻性研究将有助于制定预防多发性骨髓瘤复发的策略。