Kidney transplant patients have a higher risk of malignancy compared to the general public. The most common post-transplant malignancies are lymphoproliferative disorders (non-Hodgkin lymphomas of B cell origin) and solid tumors. AML following solid organ transplantation is less frequent. Post-transplant AML is likely a direct consequence of drug toxicity.

The treatment of the AML to achieve remission can potentially lead to failure of the kidney graft. Where renal function is still acceptable in the renal transplant patient, HSCT may be an option for patients with AML following consolidation with immunosuppression. However poor renal function is a relative contraindication to HSCT.

A key consideration is immunosuppression strategy. Calcineurin inhibitors and other induction agents known to be nephrotoxic should be avoided. A reduced dose of immunosuppression is generally used in such patients to help reduce nephrotoxicity. G-CSF may be administered to reduce infection risk. Kidney function should be closely monitored throughout the treatment of the AML and through HSCT if undertaken. DSA monitoring and biopsy may be indicated if there are signs of poor renal function. Some patients may require temporary renal replacement therapy while undergoing treatment.

HSCT donor selection should be based on standard criteria. If a fully matched related donor was used for the kidney that donor may be a good option for the HSCT.