Velcade for sensitized transplant patients – pro
Bortezomib, the first-in-class 26S proteasome inhibitor, is currently FDA approved for the treatment of multiple myeloma and relapsed mantle cell lymphoma. Proteasome inhibition reduces nuclear factor-kappa B activity and down-regulates peptide loading in class I major histocompatibility complex molecules, though its major effect is cell cycle arrest, resulting in plasma cell apoptosis and decreased antibody production. As bortezomib continues to be evaluated further as a treatment strategy for highly sensitized patients awaiting solid organ transplantation, many questions remain. A study in heart transplant candidates was recently closed and terminated for Inability to enroll within funding period, NCT01769443. Treating post-transplant immunologically mediated syndroems, however, is poorly studies and this remains an experimental approach.
Patel J, Everly M, Chang D, et al. Reduction of alloantibodies via proteosome inhibition in cardiac transplantation. J Heart Lung Transplant 2011; 30: 1320-6.Everly MJ. A summary of bortezomib use in transplantation across 29 centers. Clin Transpl 2009: 323-37.
Everly MJ, Everly JJ, Terasaki PI. Role of proteasome inhibition in sensitized transplant candidates. Chin Med J 2011; 124(5): 771-4.
Sakura Hosoba, David L. Jaye, Cynthia Cohen, John D. Roback andEdmund K. Waller,
Successful treatment of severe immune hemolytic anemia after allogeneic stem cell transplantation with bortezomib: report of a case and review of literatureTransfusion Volume 55, Issue 2, pages 259–264, February 2015