Imatinib-Treated CML: A Contraindication to Renal Transplantation?
Posted: Monday, August 24, 2020
Patients with chronic myeloid leukemia (CML) who have been treated with imatinib and have achieved a deep molecular response may be viewed as having an inactive malignancy, and therefore they may be viable candidates for renal transplantation if necessary. Daniel Cejka, MD, of Ordensklinikum Linz, Krankenhaus Elisabethinen, Austria, and colleagues published a case report of a patient with imatinib-treated CML who successfully received a kidney transplant in the American Journal of Transplantation.
The patient first developed end-stage renal disease in 1996, at the age of 34, as a result of reflux nephropathy and then received his first kidney transplant in 1999. By 2010, he had developed chronic cell-mediated rejection and allograft failure, leading to discontinuation of immunosuppressive therapy and reinitiation of hemodialysis. Diagnosed with CML in 2015 and started on imatinib in 2016, the patient was able to achieve a complete hematologic response within 3 months, a major molecular response within 6 months, and deep molecular remission within 9 months.
Due to a lack of significant comorbidities, the patient was considered to be eligible for retransplantation of the kidney. In 2017, the patient received a second kidney transplant. He was restarted on immunosuppressive medications, including basiliximab, tacrolimus, mycophenolate mofetil, and corticosteroids.
The patient has now been followed for 24 months. His most recent BCR-ABL reading showed a continuation of a deep molecular response, and he continues to receive 400 mg of imatinib daily. The patient had no delayed graft function, acute rejection, or surgical complications during or after transplantation. His most recent serum creatinine reading is 1.09 mmol/L, with an estimated glomerular filtration rate of 75 mL/min/1.73 m2. There were no reported side effects from imatinib treatment, and there was no apparent difficulty in dosing the immunosuppressants.
Disclosure: The authors reported no conflicts of interest.