{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T09:30:04Z","timestamp":1787391004289,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Kidney transplant recipients have a 2\u20134-fold higher cancer risk than the general population. The sequential occurrence of multiple myeloma (MM) and native-kidney renal cell carcinoma (RCC) is rare and creates competing priorities between anti-myeloma efficacy and allograft preservation. Case Presentation: A 54-year-old woman with a 2020 living-donor kidney transplant presented in 2024 with bone pain and shoulder swelling. Low-dose whole-body CT showed multiple punched-out osteolytic lesions. Work-up revealed IgG-\u03ba M-protein 38.5 g\/L and 25% clonal plasma cells; cytogenetics showed a complex karyotype (R-ISS III). First-line bortezomib\/cyclophosphamide\/dexamethasone (VCd) was given while maintaining tacrolimus plus low-dose steroid. After four cycles, she achieved very good partial response (M-protein 42.3 to 5.6 g\/L) with stable graft function. Follow-up imaging detected a large exophytic mass in the native right kidney; nephrectomy confirmed papillary RCC, type II. Later, the myeloma progressed with epidural extension causing cord compression. Second-line daratumumab\/carfilzomib\/dexamethasone (DKd) and palliative spine radiotherapy were initiated. The course was complicated by opportunistic infection and pancytopenia, and the patient died in January 2025. Conclusions: Vigilant post-transplant cancer surveillance\u2014including native-kidney RCC\u2014tailored immunosuppression, and multidisciplinary coordination are critical. VCd with tacrolimus may be feasible when graft preservation is prioritized; however, relapsed high-risk MM on DKd carries substantial infectious risk and a guarded prognosis.<\/jats:p>","DOI":"10.3390\/reports9010013","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T13:30:52Z","timestamp":1767187852000},"page":"13","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Post-Transplant Double Malignancy: Multiple Myeloma and Papillary Renal Cell Carcinoma\u2014A Case Report"],"prefix":"10.3390","volume":"9","author":[{"given":"Aleksandar","family":"Petrov","sequence":"first","affiliation":[{"name":"Clinic of Nephrology, University Hospital \u201cSt. Marina\u201d EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miroslava","family":"Benkova","sequence":"additional","affiliation":[{"name":"Clinic of Nephrology, University Hospital \u201cSt. Marina\u201d EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yavor","family":"Petrov","sequence":"additional","affiliation":[{"name":"Clinic of Hematology, University Hospital \u201cSt. Marina\u201d EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yana","family":"Dimieva","sequence":"additional","affiliation":[{"name":"Clinic of Nephrology, University Hospital \u201cSt. Marina\u201d EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8847-4651","authenticated-orcid":false,"given":"Mari Ara","family":"Hachmeriyan","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Genetics, University Hospital \u201cSt. Marina\u201d EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1038\/s41581-024-00820-6","article-title":"Chronic kidney disease and the global public health agenda: An international consensus","volume":"20","author":"Francis","year":"2024","journal-title":"Nat. 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