Combined histocompatibility leukocyte antigen-matched donor bone marrow and renal transplantation for multiple myeloma with end stage renal disease: the induction of allograft tolerance through mixed lymphohematopoietic chimerism

Transplantation. 1999 Aug 27;68(4):480-4. doi: 10.1097/00007890-199908270-00006.


Background: Experimental and clinical evidence has demonstrated that the establishment of allogeneic chimerism after bone marrow transplantation may provide donor-specific tolerance for solid organ allografts.

Methods: Based on the preliminary results of a clinical trial using nonmyeloablative preparative therapy for the induction of mixed lymphohematopoietic chimerism, we treated a 55-year-old woman with end stage renal disease secondary to multiple myeloma with a combined histocompatibility leukocyte antigen-matched bone marrow and renal transplant after conditioning with cyclophosphamide, antithymocyte globulin, and thymic irradiation.

Results: The posttransplant course was notable for early normalization of renal function, the absence of acute graft-versus-host disease, and the establishment of mixed lymphohematopoietic chimerism. Cyclosporine, which was the only posttransplant immunosuppressive therapy, was tapered and discontinued on day +73 posttransplant. No rejection episodes occurred, and renal function remains normal on day + 170 posttransplant (14 weeks after discontinuing cyclosporine). Although there is presently no evidence of donor hematopoiesis, there is evidence of an ongoing antitumor response with a recent staging evaluation showing no measurable urine kappa light chains. The patient remains clinically well and is off all immunosuppressive therapy.

Conclusion: This is the first report of the deliberate induction of mixed lymphohematopoietic chimerism after a nonmyeloablative preparative regimen to treat a hematological malignancy and to provide allotolerance for a solid organ transplant.

Publication types

  • Case Reports

MeSH terms

  • Bone Marrow Transplantation*
  • Chimera / immunology
  • Female
  • HLA Antigens
  • Humans
  • Immune Tolerance
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation*
  • Living Donors
  • Middle Aged
  • Multiple Myeloma / complications*
  • Multiple Myeloma / therapy*
  • Transplantation, Homologous


  • HLA Antigens