[InQ]

Kidney function and stem cell transplant eligibility

by InQ on Thu Jul 03, 2014 10:30 am

A few weeks ago, we went in for a stem cell transplant (SCT) consult. We were using it as an opportunity to learn more about the SCT as well as decide whether or not to move forward with it. However, the doctor suggested that our kidneys were not healthy enough (only at ~42% functionality).

Why do the kidneys need to be "healthy" in order to do SCT? What are the risks if one goes through with an SCT and the kidneys are not healthy enough?

Has anyone ever been turned away because their kidneys were not functional enough? What did you end up doing? Did you wait for the kidneys to heal? Continue chemo? Something else?

[Blackbird]

Re: Kidney function and stem cell transplant eligibility

by Blackbird on Thu Jul 03, 2014 11:09 am

According to my transplant doctor, the melphalan used during the SCT process is hard on the kidneys. I only have one kidney and he was especially concerned about me going through this process. I had to have extra tests done to make sure that my kidney would survive the process.

Even when I got the go ahead, he split my melphalan into two separate sessions and added an extra day between receiving the melphaln and receiving my stem cells back to give my kidney a rest.

FWIW, I appreciated his caution, but if I didn't receive the SCT, I was likely going to lose the kidney anyway.

[InQ]

Re: Kidney function and stem cell transplant eligibility

by InQ on Thu Jul 03, 2014 11:56 am

Thanks Blackbird. May I ask how was the SCT process for you? How are you doing post SCT?

[Blackbird]

Re: Kidney function and stem cell transplant eligibility

by Blackbird on Thu Jul 03, 2014 1:09 pm

Compared to some that I've read about, my transplant was textbook. I experienced some nausea, but not extreme, and minor diarrhea, but I was never bedridden. My numbers came down and back up as expected. I only needed one platelet transfusion through the whole process.

Yes, I was tired and felt weak, but when my numbers started to rebound, I started to feel better. All in all, compared to other situations I've been through, this was fairly easy for me.

Unfortunately, I guess, my experience tends to be the exception and not the rule. Everyone is different and, as such, everyone has a different experience.

[Wayne K]

Re: Kidney function and stem cell transplant eligibility

by Wayne K on Thu Jul 03, 2014 1:22 pm

I started my SCT with a GFR of 30. I was told that they were going to reduce the melphalan dosage. They didn't think it would affect the transplant and I remained in remission for 3 1/2 years without maintenance. I was told earlier that they would not do one if I was on dialysis.

Perhaps it is time for a second opinion?

[Dr. Ken Shain]

Re: Kidney function and stem cell transplant eligibility

by Dr. Ken Shain on Sat Jul 05, 2014 10:10 am

Renal function itself is not an absolute contraindication (no go) to HDM-ASCT (high-dose melphalan - autologous stem cell transplantation). However, it increases the risks associated with the procedure -- really, the potential toxicities of the high dose melphalan and treatments that might be necessary for toxicities associated with the melphalan. It would be something that might push someone into not having a transplant based on other comorbidities (risk factors) that would make the risk benefit of HDM-ASCT too significant .

Depending on where you are in induction therapy, you may also have the potential for further im­prove­ment with continued therapy.

Allogeneic transplants, in our experience, should not be undergone in the setting of frank renal disease or even a history (presentation) of renal disease associated with multiple myeloma.