Weston M, Rolfe M, Haddad T, Lopez-Cepero M
LifeLink Health Care Institute, Tampa, Florida, USA.
Clin Transpl. 2009:393-9.
The use of bortezomib in combination with other desensitization therapies like plasmapheresis, IVIG, and rituximab has allowed the decrease of antibody levels during treatment in some patients. However, all patients described here have experienced rebound effects to the same or higher levels than the ones before therapy was started. Unfortunately, no donors became available to some of these patients when their antibodies were at lower levels. Three out of the four patients presented had adverse reactions to bortezomib which include nausea, vomiting, diarrhea, myalgias and severe neuropathy. In one patient (pre-heart transplant patient #1) we noticed that some clones were selectively more susceptible to the treatment with bortezomib than others. We will continue antibody monitoring in this patient and hopefully the possibility is there, even though the overall PRA is not reduced, that certain clones will be affected and no longer produced antibody allowing these patients a wider selection of acceptable donors.
硼替佐米与其他脱敏疗法（如血浆置换、静脉注射免疫球蛋白和利妥昔单抗）联合使用，已使部分患者在治疗期间抗体水平降低。然而，此处描述的所有患者都经历了抗体水平反弹，达到或高于治疗开始前的水平。不幸的是，其中一些患者抗体水平较低时，仍未找到合适的供体。四名患者中有三名出现了硼替佐米的不良反应，包括恶心、呕吐、腹泻、肌痛和严重神经病变。在一名患者（心脏移植前患者#1）中，我们注意到某些克隆对硼替佐米治疗的敏感性比其他克隆更高。我们将继续对该患者进行抗体监测，尽管总体群体反应性抗体（PRA）未降低，但仍有可能某些克隆受到影响，不再产生抗体，从而使这些患者有更多可接受的供体可供选择。
