From the Guidelines
Yes, people who have had a radical nephrectomy for cancer can generally undergo a stem cell transplant, as chronologic age and renal function should not be the sole criteria used to determine eligibility for SCT 1. When considering a stem cell transplant for individuals who have undergone a radical nephrectomy, several key factors come into play, including the patient's overall health, the time elapsed since their cancer treatment, their current cancer status, the function of their remaining kidney, and the specifics of the planned stem cell transplant.
- The patient's current health status and ability to tolerate the transplant process are crucial, with particular attention to their renal function given the nephrotoxic potential of the conditioning regimen and post-transplant medications.
- The time since cancer treatment and the patient's current cancer status (whether in remission or with active disease) are significant, as the risk of cancer recurrence must be carefully weighed against the potential benefits of the transplant.
- Kidney function is a critical consideration because the chemotherapy and other medications involved in the transplant process can be harmful to the kidneys, and patients with a single kidney may have limited reserve to tolerate such insults.
- Comprehensive pre-transplant evaluation is essential, including assessments of kidney function, cardiac health, pulmonary status, and screening for infectious diseases, to identify any potential risks or contraindications.
- The transplant team must work closely with the patient's oncologist and nephrologist to design a conditioning regimen that effectively prepares the patient for the transplant while minimizing the risk of kidney damage.
- Maintaining excellent hydration before, during, and after the transplant is vital to support the function of the remaining kidney and overall health. According to the guidelines for the treatment of multiple myeloma, patients should be referred to a transplant center to determine transplant eligibility, and up-front transplant should be offered to all transplant-eligible patients 1.
From the Research
Radical Nephrectomy and Stem Cell Transplant
- There is no direct evidence to suggest that people who had a radical nephrectomy for cancer cannot undergo a stem cell transplant.
- However, studies have shown that radical nephrectomy can have long-term effects on renal function, with some patients progressing to hemodialysis or experiencing renal deterioration 2.
- The decision to perform a radical nephrectomy or a partial nephrectomy depends on various factors, including the size and location of the tumor, the patient's overall health, and the presence of any comorbidities 3.
- Some studies have suggested that nephron-sparing procedures, such as partial nephrectomy, may be a better option for patients with smaller renal tumors and a normal contralateral kidney, as they can help preserve renal function 2, 4.
- In terms of blood loss and transfusion requirements, radical nephrectomy for localized renal cell carcinoma is generally well-tolerated, but nephrectomy for advanced disease may carry a higher risk of significant blood loss and transfusion 5.
- Long-term renal function recovery following radical nephrectomy for kidney cancer has been studied, and results suggest that a significant proportion of patients can recover to their preoperative estimated glomerular filtration rate within 2 years 6.