Table 1.

Demographics, clinical characteristics, MM treatment course and renal transplant outcomes

	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5
Demographics
Age (at time of diagnosis MM, years)	63	54	37	48	64
Sex	M	M	M	F	F
Ethnicity	Caucasian	Caucasian	Caucasian	Caucasian	Caucasian
Timeline
Date of diagnosis of MM and presentation of renal disease	December 2006	July 2010	March 2008	March 2011	March 2012
Time from MM diagnosis to ASCT (months)	25	10	11	10	10
Time from ASCT to kidney transplantation (months)	42	33	14	27	16
Time from MM diagnosis to kidney transplantation (months)	67	43	25	37	26
Time from kidney transplantation to relapse (months)	6	N/A	16	N/A	N/A
Date of death	February 2016	N/A	April 2014	N/A	N/A
Time of follow-up from kidney transplantation (months)	55	53	48	56	55
Details of MM
Stage at diagnosis	Stage III ISS	Stage III ISS	Stage III ISS	Stage III ISS	Stage III ISS
SFLC at diagnosis (mg/L)	Not available at our hospital in 2006	Kappa 9.25 Lambda 23 400.00 Ratio <0.01	Kappa 2150.00 Lambda 18.50 Ratio 116.22	Kappa 3090.00 Lambda 18.10 Ratio 170.2	Kappa 7.97 Lambda 163.00 Ratio <0.01
Bone marrow biopsy	50% plasma cells, IgA Kappa	90% plasma cells, Lambda Light Chain	80% plasma cells, IgG Kappa	5% plasma cells, non-secretory	90% plasma cells, Lambda Light chain
Chemotherapy pre-ASCT	TD × 6	CTD × 1 VCD × 6	CTD × 6	TD × 6	CTD × 1 PAD × 2 CVTD × 6
Achieved VGPR/CR (months after diagnosis MM)	25	8	11	10	10
ASCT chemotherapy	HDM 100 mg/m2	HDM 140 mg/m2	HDM 140 mg/m2	HDM 140 mg/m2	HDM 140 mg/m2
Details of relapse of MM
First relapse of MM post ASCT (months)	48	No, remains in CR	30	No, remains in CR	No, remains in CR
First relapse of MM post kidney transplantation (months)	6	N/A	16	N/A	N/A
SFLC at first relapse (mg/L)	Kappa 1488.00 Lambda 0.63 Ratio 2361.9	N/A	Kappa 817.65 Lambda 16.89 Ratio 48.4	N/A	N/A
Bone marrow biopsy at first relapse	50% plasma cells	N/A	Not conducted	N/A	N/A
Chemotherapy for first relapse	VCD × 3	N/A	VCD × 5 lenalidomide/dexamethasone bendamustine/bortezomib × 4 CTD × 6	N/A	N/A
Haematological response achieved after treatment of first  relapse	CR	N/A	VGPR	N/A	N/A
Second relapse of MM post kidney transplantation (months)	38	N/A	31	N/A	N/A
SFLC at second relapse (mg/L)	Kappa 1464 Lambda 1.25 Ratio 1171.20	N/A	Kappa 683.24 Lambda 15.80 Ratio 43.2	N/A	N/A
Bone marrow biopsy at second relapse	70% plasma cells	N/A	Not conducted	N/A	N/A
Chemotherapy for second relapse	Bendamustine/dexamethasone × 7	N/A	Melphalan	N/A	N/A
Adverse impacts of chemotherapy	No	No	Bortezomib – peripheral neuropathy	No	Bortezomib – peripheral neuropathy
Details of renal disease and transplantation
Renal involvement at presentation of MM	Yes	Yes	Yes	Yes	Yes
Renal biopsy results	Cast nephropathy	Cast nephropathy and tubule-interstitial nephritis	Cast nephropathy	Cast nephropathy	Cast nephropathy
Type of renal allograft	ABO-incompatible, live related	Live unrelated	Live related	Deceased DBD	Deceased DBD
HLA mismatch	1-2-1	1-2-1	1-1-1	0-0-0	1-1-0
Induction immunosuppression	(Pre-transplant: 5 × sessions of double filtration plasmapheresis Rituximab 375 mg/m2) Basiliximab	Basiliximab	Basiliximab	Basiliximab	Basiliximab
Maintenance immunosuppression	Tacrolimus, MMF and prednisolone	Tacrolimus, MMF and prednisolone	Ciclosporin, MMF and prednisolone	Tacrolimus, MMF and prednisolone	Tacrolimus, MMF and prednisolone
eGFR (mL/min) at:
1 year	78	63	43	15	35
2 years	76	61	38	Haemodialysis	38
Last follow-up	29	Haemodialysis	14	Haemodialysis	27
UPCR (mg/mmol) at:
Pre-transplant	13	19	Not tested	Not tested	Not tested
1 year	15	13	11	Not tested	Not tested
2 years	48	20	35	Not tested	Not tested

DBD, donation after brain death; F, female; M, male; ISS, International Staging System; HDM, high-dose melphalan; N/A, not applicable; MMF, mycophenolate mofetil; TD, thalidomide/dexamethasone.