An update on antibody reduction and rejection reversal following bortezomib use: a report of 52 cases across 10 centers.

Based on the analysis of the 52 patient cases submitted for the Antibody Treatment Report of Clinical Transplants 2010, there is growing evidence that bortezomib is a viable option for antibody mediated rejection (AMR). Today, some centers have even chosen to use bortezomib as a first line agent in their AMR cases. In desensitization, from the current available data the use of bortezomib to desensitize patients is still under investigation. The optimal number of cycles as well as predictors of those who bortezomib may be useful still remain major questions. Continued data in this area is necessary and at this point bortezomib is a viable option and should be considered as part of some patients' desensitization regimen. Finally, in the area of chronic alloantibody mediated rejection (CAMR), there is exciting new data that bortezomib may have additional benefits and may provide a few more months of survival based on its effect to reduce proteinuria. However, in the CAMR cases it is clear that the damage that has already occurred due to persistent alloantibody is irreversible. This indicates that earlier treatment of alloantibodies in patients should occur to provide the best chance of allograft success.