Horizons in TransplantationKidney transplantationAdjuvant Chemotherapy With Gemcitabine Plus Cisplatin for Kidney Transplant Patients With Locally Advanced Transitional Cell Carcinoma: A Single-center Experience

- Adjuvant chemotherapy with gemcitabine plus cisplatin improves prognosis compared with surgery alone.
- The drugs toxicities were acceptable, and the nephrotoxicity was mild.
- Adjuvant chemotherapy with gemcitabine plus cisplatin should be considered for kidney transplant patients with locally advanced transitional cell carcinoma.

BackgroundThe purpose of the present study was to evaluate the effects and safety of adjuvant chemotherapy with gemcitabine plus cisplatin in kidney transplant patients with locally advanced transitional cell carcinoma.MethodsA total of 22 kidney transplant patients with locally advanced transitional cell carcinoma were assessed. Eleven patients who underwent surgery and received adjuvant chemotherapy were enrolled in the study. They were compared with 11 matched patients who were treated with surgery alone. The chemotherapy regimen was gemcitabine 800 mg/m2 on days 1, 8, and 15 and cisplatin 70 mg/m2 on day 2. A single treatment cycle lasted 28 days. Because of the potential concerted reaction between the immunosuppressant regimen and the chemotherapeutic agents, drug toxicities were closely observed, and a dose reduction of the chemotherapeutic agents was planned according to the toxicity grade. There was a 75% drug dose reduction for grade 2 hematologic toxicities and grade 1 nephrotoxicity, and there was a 50% drug dose reduction for grade 3 hematologic toxicity and grade 2 nephrotoxicity. Patients who developed grade 4 hematologic toxicity or grade 3 to 4 nephrotoxicities were withdrawn.ResultsEleven patients completed a total of 29 cycles. At a median follow-up time of 21 months, the mean overall survival time was longer than that of the observation group (P = .043). The incidence of hematologic toxicities was higher, resulting in a dose reduction of the chemotherapeutic agents in 45.5% of patients. Gastrointestinal reactions were most common in patients with nonhematologic toxicities. Grade 1 nephrotoxicity was reported in 3 patients; no other grade of nephrotoxicity was observed. Levels of serum creatinine and blood urea nitrogen were not obviously reduced during chemotherapy.ConclusionsOur study data suggest that kidney transplant patients with locally advanced transitional cell carcinoma may derive an overall survival benefit from the administration of adjuvant chemotherapy with gemcitabine plus cisplatin after surgery. The drug toxicities were acceptable, and nephrotoxicity was mild.