Haploidentical Hematopoietic Cell and Kidney Transplantation for Hematological Malignancies and End-Stage Renal Failure

At Massachusetts General Hospital (MGH), we pioneered simultaneous hematopoietic cell (HCT) / kidney transplantation from HLA-identical related donors for the treatment of hematological malignancies with end-stage renal failure (ESRD). We have now extended this to HLA-haploidentical donors in a pilot trial (NCT01758042). Six recipients underwent combined HCT / kidney transplantation from haploidentical donors, five of whom were conditioned with fludarabine, cyclophosphamide and total body irradiation; graft-vs.-host disease (GVHD) prophylaxis included post-HCT cyclophosphamide, tacrolimus and mycophenolate mofetil. One patient died from complications of fludarabine neurological toxicity. No neurological toxicity was observed in subsequent patients who received lower fludarabine doses and more intense post-fludarabine dialysis. There were no cases of grades II-IV acute GVHD and one case of moderate chronic GVHD by 12 months. One patient experienced relapse of multiple myeloma at 30 months after HCT and died four years post-transplant. Overall, four of six patients remain alive, without disease relapse and with long-term renal rejection-free survival.