From the Guidelines
Yes, people who have had a radical nephrectomy can be considered for a stem cell transplant, as chronologic age and renal function should not be the sole criteria used to determine eligibility for SCT. According to the treatment of multiple myeloma guideline by ASCO and CCO 1, the decision to proceed with a stem cell transplant should be based on a comprehensive assessment of the patient's overall health, including their renal function, rather than the sole fact that they have had a radical nephrectomy.
When evaluating a patient with a history of radical nephrectomy for stem cell transplant eligibility, several factors should be considered, including:
- The reason for the nephrectomy
- Time since surgery
- Current health status
- Overall kidney function, as assessed by tests such as creatinine clearance and GFR
- The potential for the remaining kidney to handle the metabolic demands and toxicities associated with the transplant process
As stated in the guideline, agents associated with stem-cell toxicity, such as melphalan and/or prolonged immunomodulatory drug exposure, should be avoided in patients who are potential candidates for stem-cell transplant 1. The transplant team may need to adjust conditioning regimens and medications to be less nephrotoxic and carefully monitor fluid balance to protect the remaining kidney function during the transplant process. Patients should inform their transplant team about their nephrectomy history early in the evaluation process to ensure appropriate planning and risk assessment.
From the Research
Radical Nephrectomy and Stem Cell Transplant
- There is no direct evidence in the provided studies that discusses the relationship between radical nephrectomy and stem cell transplant.
- However, the studies suggest that radical nephrectomy can lead to a decline in renal function, with some patients experiencing chronic kidney disease (CKD) in the long term 2, 3.
- The recovery of renal function after radical nephrectomy varies among patients, with some studies suggesting that 45% of patients can recover to their preoperative estimated glomerular filtration rate within 2 years 4.
- Factors such as preoperative renal function, tumor size, and patient gender can influence the recovery of renal function after radical nephrectomy 4.
- While the provided studies do not directly address the question of stem cell transplant, they highlight the importance of considering renal function and potential long-term complications when evaluating treatment options for patients who have undergone radical nephrectomy 5, 2, 3, 4, 6.