title: Treatment of Multiple Myeloma in a Heart Transplant Recipient.
abstract: Malignancy following solid organ transplant remains a significant threat to the survival of cardiac transplant recipients. Plasma cell dyscrasias including multiple myeloma have been encountered in this population, and medication treatments traditionally used to treat these disorders demonstrate immunomodulatory effects that may have implications on the transplanted allograft. Lenalidomide is an immunomodulatory agent that has been used to treat plasma cell disorders, including light-chain amyloidosis (AL) and multiple myeloma, and represents such a class of medications in which the risks and benefits in the solid organ transplant population remain to be fully elucidated. This report highlights a clinical practice issue where the treatment of a patient's multiple myeloma with lenalidomide may have potentiated an episode of severe acute cellular rejection and further demonstrates the need for future investigation of the optimal treatment of plasma cell disorders including AL amyloidosis and multiple myeloma following solid organ transplantation.
authors.affiliation: 1 Division of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Lola
authors.initials: L
authors.lastname: Xie
authors.affiliation: 1 Division of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Jozwik
authors.affiliation: 2 Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, TX, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Weeks
authors.affiliation: 3 Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: L Maximilian
authors.initials: LM
authors.lastname: Buja
authors.affiliation: 3 Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Brown
authors.affiliation: 4 Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Sriram
authors.initials: S
authors.lastname: Nathan
authors.affiliation: 4 Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Keshava
authors.initials: K
authors.lastname: Rajagopal
authors.affiliation: 1 Division of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Paruthi
authors.affiliation: 4 Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
authors.affiliation: 4 Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Pranav
authors.initials: P
authors.lastname: Loyalka
authors.affiliation: 4 Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Indranee
authors.initials: I
authors.lastname: Rajapreyar
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D001706:Biopsy; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D006084:Graft Rejection / Q000628:therapy; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000188:drug therapy
keywords: acute cellular rejection; heart transplant; lenalidomide