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Role of proteasome inhibition in sensitized transplant candidates.

OBJECTIVE
To review this efficacy and safety of bortezomib, a proteasome inhibitor, in the setting of the sensitized transplant candidate.


DATA SOURCES
The data used in this review were from articles published (PubMed) between 2000 to 2010. Additionally abstracts from medical meetings related to transplant were also used.


STUDY SELECTION
Articles were selected if they were trial results or case studies for the use of bortezomib in the sensitized patient population.


RESULTS
The early data using bortezomib as a part of desensitization regimens has shown success. Although one cycle (4 doses) of bortezomib seems to have affect on many patients, it also seems likely that to provide complete desensitization multiple cycles will be required. Regarding safety, bortezomib has been shown to have minimal side effects. The most common side effects reported are those of thrombocytopenia and anemia. These side effects are dose related and self limiting upon discontinuation of the treatment.


CONCLUSIONS
Bortezomib with plasmapheresis is a promising new alternative to desensitization protocols that use either high dose intravenous immune globulin (IVIG) or low dose IVIG and plasmapheresis. The efficacy on antibody reduction looks to be batter that that of the IVIG based regimens without significant addition toxicity. The results of ongoing prospective trials are positive and their complete results are greatly anticipated.