RESUMO
Highly sensitized patients represent a challenge in all transplant programs. The use of bortezomib in combination with other strategies could be a real option for some patients. Unfortunately, one single cycle of four doses of bortezomib with 3 PP sessions may not be sufficient. With all the agents available to use in desensitization it is still not clear what is the best combination or who are the best candidates. We need more time and experience with its use to identify which patients could be the best candidate to receive it for desensitization.
Assuntos
Ácidos Borônicos/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim , Inibidores de Proteases/uso terapêutico , Pirazinas/uso terapêutico , Doadores de Tecidos/provisão & distribuição , Listas de Espera , Adulto , Bortezomib , Regulação para Baixo , Feminino , Sobrevivência de Enxerto/efeitos dos fármacos , Antígenos HLA/imunologia , Humanos , Isoanticorpos/sangue , Transplante de Rim/imunologia , Masculino , México , Pessoa de Meia-Idade , Seleção de Pacientes , Plasmaferese , Complexo de Endopeptidases do Proteassoma/metabolismo , Inibidores de Proteassoma , Fatores de Tempo , Resultado do TratamentoRESUMO
The use of bortezomib as a treatment modality of AHR improved and stabilized graft function (clinical response) in the majority of patients. Its use in single dose, even combined with rituximab, does not seem to be useful to obtain a sustained clinical response, or to reduce HLAabs level. The use of 4 doses of bortezomib in days 1, 4, 7, and 10 (1.3 mg/m2 BSA each) plus plasmapheresis produced both a good clinical response and a reduction in DSA. Moving forward, it will be necessary to define the long-term effectiveness of bortezomib and whether rituximab administration is indispensable to achieve this goal. Until now, it is evident that many patients needed retreatment and they were well tolerated.
Assuntos
Academias e Institutos , Ácidos Borônicos/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Imunidade Humoral/efeitos dos fármacos , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Inibidores de Proteases/uso terapêutico , Pirazinas/uso terapêutico , Doença Aguda , Adulto , Ácidos Borônicos/administração & dosagem , Bortezomib , Esquema de Medicação , Feminino , Rejeição de Enxerto/imunologia , Antígenos HLA/imunologia , Humanos , Imunossupressores/administração & dosagem , Isoanticorpos/sangue , Masculino , México , Pessoa de Meia-Idade , Plasmaferese , Inibidores de Proteases/administração & dosagem , Complexo de Endopeptidases do Proteassoma/metabolismo , Inibidores de Proteassoma , Pirazinas/administração & dosagem , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
The use of bortezomib as a treatment modality of AHR improved and stabilized graft function (clinical response) in the majority of patients. Its use in single dose, even combined with rituximab, does not seem to be useful to obtain a sustained clinical response neither to reduce HLAabs level. The use of 4 doses of bortezomib in days 1, 4, 7, and 10 (1.3 mg/m2 BSA each) plus plasmapheresis produced both a good clinical response and a reduction in DSA. Moving forward, it will necessary to define the long-term effectiveness of bortezomib and whether rituximab administration is indispensable to achieve this goal.
