Metastatic Urothelial Carcinoma from Transplanted Kidney with Complete Response to an Immune Checkpoint Inhibitor
Background. Donor-derived malignancy is a rare complication in patients who undergo organ transplant. Approaches to treatment have largely been individualized based on clinical circumstances given the lack of evidence-based guidelines, with therapeutic options ranging from discontinuation of immunos...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Urology |
| Online Access: | http://dx.doi.org/10.1155/2020/8881841 |
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| author | Ryan S. Chiang Ashton A. Connor Brant A. Inman Wen-Chi Foo David N. Howell John F. Madden Matthew J. Ellis Aparna S. Rege Michael R. Harrison |
| author_facet | Ryan S. Chiang Ashton A. Connor Brant A. Inman Wen-Chi Foo David N. Howell John F. Madden Matthew J. Ellis Aparna S. Rege Michael R. Harrison |
| author_sort | Ryan S. Chiang |
| collection | DOAJ |
| description | Background. Donor-derived malignancy is a rare complication in patients who undergo organ transplant. Approaches to treatment have largely been individualized based on clinical circumstances given the lack of evidence-based guidelines, with therapeutic options ranging from discontinuation of immunosuppression and transplantectomy to the addition of chemotherapy or radiotherapy. Case Presentation. Herein, we describe a 60-year-old woman with metastatic donor-derived upper tract urothelial carcinoma (UTUC) discovered nine years postrenal transplant. Molecular diagnostic studies using polymerase chain reaction amplification of short tandem repeat alleles and HLA tissue typing proved that the urothelial carcinoma originated from donor tissue. She achieved sustained complete remission with transplant nephroureterectomy, retroperitoneal lymphadenectomy, immunosuppression withdrawal, and immunotherapy with pembrolizumab. Routine radiologic surveillance has demonstrated 15-month progression-free survival to date off pembrolizumab, and she is now under consideration for retransplantation. Conclusions. Immunotherapy using checkpoint inhibitors can serve as a novel treatment option for patients in the clinical predicament of having a solid organ transplant and simultaneous metastatic malignancy. In this report, we also discuss the oncogenic potential of BK virus, the use of checkpoint inhibitors in urothelial carcinoma, and the feasibility of retransplant for this patient population. |
| format | Article |
| id | doaj-art-e731ead58cfb4626a4e99875e59a895d |
| institution | Kabale University |
| issn | 2090-696X 2090-6978 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Urology |
| spelling | doaj-art-e731ead58cfb4626a4e99875e59a895d2025-02-03T01:03:58ZengWileyCase Reports in Urology2090-696X2090-69782020-01-01202010.1155/2020/88818418881841Metastatic Urothelial Carcinoma from Transplanted Kidney with Complete Response to an Immune Checkpoint InhibitorRyan S. Chiang0Ashton A. Connor1Brant A. Inman2Wen-Chi Foo3David N. Howell4John F. Madden5Matthew J. Ellis6Aparna S. Rege7Michael R. Harrison8Department of Medicine, Stanford University Medical Center, Stanford, CA, USADivision of Abdominal Transplant Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USADivision of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USADepartment of Pathology, Duke University School of Medicine, Durham, NC, USADepartment of Pathology, Duke University School of Medicine, Durham, NC, USADepartment of Pathology, Duke University School of Medicine, Durham, NC, USADivisions of Nephrology and Abdominal Transplant, Departments of Medicine and Surgery, Duke University School of Medicine, Durham, NC, USADivision of Abdominal Transplant Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USADivision of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, NC, USABackground. Donor-derived malignancy is a rare complication in patients who undergo organ transplant. Approaches to treatment have largely been individualized based on clinical circumstances given the lack of evidence-based guidelines, with therapeutic options ranging from discontinuation of immunosuppression and transplantectomy to the addition of chemotherapy or radiotherapy. Case Presentation. Herein, we describe a 60-year-old woman with metastatic donor-derived upper tract urothelial carcinoma (UTUC) discovered nine years postrenal transplant. Molecular diagnostic studies using polymerase chain reaction amplification of short tandem repeat alleles and HLA tissue typing proved that the urothelial carcinoma originated from donor tissue. She achieved sustained complete remission with transplant nephroureterectomy, retroperitoneal lymphadenectomy, immunosuppression withdrawal, and immunotherapy with pembrolizumab. Routine radiologic surveillance has demonstrated 15-month progression-free survival to date off pembrolizumab, and she is now under consideration for retransplantation. Conclusions. Immunotherapy using checkpoint inhibitors can serve as a novel treatment option for patients in the clinical predicament of having a solid organ transplant and simultaneous metastatic malignancy. In this report, we also discuss the oncogenic potential of BK virus, the use of checkpoint inhibitors in urothelial carcinoma, and the feasibility of retransplant for this patient population.http://dx.doi.org/10.1155/2020/8881841 |
| spellingShingle | Ryan S. Chiang Ashton A. Connor Brant A. Inman Wen-Chi Foo David N. Howell John F. Madden Matthew J. Ellis Aparna S. Rege Michael R. Harrison Metastatic Urothelial Carcinoma from Transplanted Kidney with Complete Response to an Immune Checkpoint Inhibitor Case Reports in Urology |
| title | Metastatic Urothelial Carcinoma from Transplanted Kidney with Complete Response to an Immune Checkpoint Inhibitor |
| title_full | Metastatic Urothelial Carcinoma from Transplanted Kidney with Complete Response to an Immune Checkpoint Inhibitor |
| title_fullStr | Metastatic Urothelial Carcinoma from Transplanted Kidney with Complete Response to an Immune Checkpoint Inhibitor |
| title_full_unstemmed | Metastatic Urothelial Carcinoma from Transplanted Kidney with Complete Response to an Immune Checkpoint Inhibitor |
| title_short | Metastatic Urothelial Carcinoma from Transplanted Kidney with Complete Response to an Immune Checkpoint Inhibitor |
| title_sort | metastatic urothelial carcinoma from transplanted kidney with complete response to an immune checkpoint inhibitor |
| url | http://dx.doi.org/10.1155/2020/8881841 |
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