硼替佐米联合利妥昔单抗和血浆置换治疗高致敏等待肾移植患者

Bortezomib combined with rituximab and plasmapheresis for the treatment of highly sensitized renal transplant candidates

背景:高致敏是肾移植成功的障碍,目前肾移植脱敏治疗方法有静注免疫球蛋白、血浆置换、兔抗人淋巴细胞球蛋白等,但治疗效果常不满意。目的:通过利妥昔单抗和硼替佐米进行肾移植后脱敏治疗,寻求效果满意的治疗方案。方法:1例高致敏等待肾移植患者接受脱敏治疗,接受血浆置换2次后,立即给予利妥昔单抗500mg静滴,2d后开始分别在第1,4,8,11天给予硼替佐米1.3mg/m2,随访观察群体反应性抗体等变化。结果与结论:随访的9个月中,患者群体反应性抗体从92%下降到17%,患者对利妥昔单抗和硼替佐米有良好的耐受性。初步经验表明:硼替佐米联合利妥昔单抗和血浆置换三联脱敏治疗方案可快速持久降低循环抗体水平,硼替佐米可能成为脱敏治疗方案中的重要要素。

BACKGROUND： Highly sensitized is the barrier to successful renal transplantation. At present, the renal transplant desensitization treatment methods include the intravenous immunoglobulin, plasmapheresis and rabbit anti-human lymphocyte globulin, but the treatment effect is often unsatisfied. OBJECTIVE： To perform the desensitization treatment through bortezomib and rituximab in order to find a treatment regimen with satisfactory results. METHODS： One highly sensitized renal transplant candidate was selected to receive triple desensitization treatment. After plasmapheresis treatment, intravenous infusion of 500 mg rituximab was performed immediately. After infusion for 2 days, 1.3 mg/m2 bortezomib was injected at 1, 4, 8 and 11 days. The panel reactive antibody was observed during follow-up. RESULTS AND CONCLUSION： During a nine-month follow-up period, cytotoxic panel reactive antibody decreased from 92% to17%. The patient represented no adverse effects. Our initial experience suggests that triple desensitization treatment of plasmapheresis, rituximab and bortezomib was effective to reduce circulating antibodies against human leucocyte antigen. Bortezomib may be useful in desensitization protocols.