Donor specific alloantibody producing plasma cells might be a good target for proteosomic inhibition by bortezomib. Bortezomib has some data in case series and reports of treating antibody mediated rejection. A recent study published in Transplantation 2011 discussed case series of 4 patients with extremely high DSA and couldn't just get apheresis alone. They received 4 doses of bortezomib alone in one group and other 4 received 16 doses and plasma exchange. The response of these 8 patients was compared to 8 patients with plasma exchange alone. Bortezomib alone didn't do much but bortezomib + plasma exchange did better than just plasma exchange alone in terms of DSA decrease. This might lead to more protocols that might develop using this agent for treatment of desensitization.
This study is small and not well designed. IVIG has been used in many centers and Anti CD20 agents as well. Is it bortezomib alone that is doing the magic or is it that we just need two agents along with plasma exchange. So plasma exchange + IVIG pr plasma exchange + rituximab or plasma exchange + bortezomib.
This study is small and not well designed. IVIG has been used in many centers and Anti CD20 agents as well. Is it bortezomib alone that is doing the magic or is it that we just need two agents along with plasma exchange. So plasma exchange + IVIG pr plasma exchange + rituximab or plasma exchange + bortezomib.
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