Department of Cardiac, Thoracic and Vascular Sciences, University Hospital, Padua, Italy.
Transpl Int. 2014 May;27(5):e38-42. doi: 10.1111/tri.12270. Epub 2014 Feb 17.
Giant cell myocarditis (GCM) is a very aggressive form of myocardial inflammation. While immunosuppressive therapy is usually able to keep under control the disease and prolong the average transplant-free survival in many patients, effective therapeutic strategies to prevent or treat the recurrence of GCM in transplanted organs are still to be defined. We report the case of a young woman with idiopathic GCM who, despite immediate aggressive immunosuppressive therapy, rapidly progressed to irreversible heart failure and required urgent heart transplantation. Yet, 2 months later, the disease recurred in the transplanted heart, despite an intensive four-drug antirejection regimen. The introduction of rituximab, an anti-CD20 monoclonal antibody, 375 mg/m(2) /week i.v. for four consecutive weeks and then every 4 months as maintenance therapy, determined a complete and steady clinical remission of the disease. After nineteen months since rituximab administration, the patient is doing well and repeated follow-up endo-myocardial biopsies confirmed the complete resolution of myocardial inflammation. Our experience seems to suggest that rituximab can be a reasonably effective and safe therapeutic option in GCM recurring in transplanted organs.
巨细胞心肌炎（GCM）是一种侵袭性很强的心肌炎症。虽然免疫抑制疗法通常能够控制疾病并延长许多患者的平均无移植存活期，但预防或治疗移植器官中 GCM 复发的有效治疗策略仍有待确定。我们报告了一例特发性 GCM 年轻女性患者的病例，尽管立即进行了积极的免疫抑制治疗，但她的病情仍迅速进展为不可逆性心力衰竭，需要紧急进行心脏移植。然而，2 个月后，尽管采用了强化的四联抗排斥方案，但移植心脏中的疾病仍复发了。每周静脉注射 375mg/m² 的利妥昔单抗（一种抗 CD20 单克隆抗体）连续 4 周，然后每 4 个月作为维持治疗，可使疾病完全稳定缓解。自利妥昔单抗治疗 19 个月以来，患者情况良好，重复的心肌内活检证实了心肌炎症的完全消退。我们的经验似乎表明，利妥昔单抗可能是治疗移植器官中复发的 GCM 的一种合理有效且安全的治疗选择。
