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Is Kidney Transplantation a Relative Indication for Patients with Chronic Myeloid Leukemia (CML) in Sustained Remission with Imatinib?

Tadahiko Tokumoto*, Kiyoshi Setoguchi, Kazutaka Saito

Currently, kidney transplantation is absolutely contraindicated for patients with Chronic Renal Failure (CRF) with active malignancy. However, there is controversy as to whether kidney transplantation can be safely performed in patients with a history of Chronic Myeloid Leukemia (CML) in remission. In this report, a 64-year-old male patient was diagnosed with CML approximately 17 years ago, achieved cytogenetic and molecular remission promptly after starting Imatinib, and remained in remission for more than 15 years with Imatinib therapy. However, Chronic Kidney Disease (CKD) due to DMN gradually worsened, and the patient underwent preemptive living donor kidney transplantation in July 2020. Imatinib for CML was discontinued because the patient maintained Deep Molecular Remission (DMR) of Major Molecular Response (MMR) for more than 15 years prior to kidney transplantation. After the kidney transplantation, the transplanted kidney function remained good at around serum Creatinine (s-Cr) 1.1 mg/dL without histopathological rejection, and the 3 monthly BCR-ABL1 measurement results were negative and are in progress. Thus, he continues to maintain Treatment-Free Remission (TFR) status without imatinib for 35 months after kidney transplantation. In conclusion, this result suggests that CML with long-lasting DMR on imatinib therapy can be considered an inactive malignancy and therefore a relative indication for kidney transplantation.