Safety and efficacy of high dose melphalan and autologous stem cell transplantation prior to renal allograft in end-stage renal failure secondary to Monoclonal Immunoglobulin Deposition Disease

Monoclonal immunoglobulin deposition disease (MIDD) nearly always has renal involvement and frequently leads to end stage renal failure (ESRF). Renal transplantation is not usually considered due to an almost universal recurrence of the disease and poor survival of the renal allograft. We report the case of a 36-year-old female who was treated with induction chemotherapy followed by high dose melphalan and autologous stem cell transplantation and subsequently received a live related renal transplant from her sister. She had no rejection or major post transplant complications, and showed no signs of recurrence of disease after over 2 years of follow up. Our case suggests this mode of therapy could be considered in carefully selected patients with ESRF due to MIDD.