Bortezomib Eliminates Plasma Cells From a Renal Graft in Plasma Cell–Rich Acute Rejection

Masayuki Tasaki, Kazuhide Saito, Yuki Nakagawa, Masahiro Ikeda, Naofumi Imai, Yumi Ito, Masanori Sudo, Yohei Ikezumi, Takeshi Yamada, Hiroya Hasegawa, Takashi Kobayashi, K. Miura, I. Narita, Kota Takahashi, Yoshihiko Tomita

Research output: Contribution to journalArticle

Abstract

Plasma cell–rich acute rejection (PCAR) and antibody-mediated rejection (ABMR), for which a standard treatment has not yet been established, are associated with poor graft survival after kidney transplantation. Here, we report a case series of 3 Japanese patients diagnosed with PCAR accompanied by ABMR. Steroid pulse therapy and rabbit antithymocyte globulin, plasma exchange, intravenous immunoglobulin, and rituximab therapies were sequentially performed in the first case. A graft biopsy after each treatment showed that plasma cell infiltration persisted. Five months after the initiation of rejection therapy, the patient was subjected to bortezomib therapy, which led to the partial elimination of plasma cells from the graft. However, the graft function gradually deteriorated, and hemodialysis treatment was warranted. In the other 2 cases, the patients received the same combination of therapy including bortezomib within a short period. Graft biopsies performed subsequently showed a marked decrease in the number of infiltrated plasma cells, and stabilization of renal graft function was achieved in both cases. Bortezomib, which targets plasma cells, is a potent drug that eliminates infiltrated plasma cells from the graft in PCAR. Thus, in addition to conventional therapy comprising plasma exchange, intravenous immunoglobulin, and rituximab against ABMR, bortezomib may be necessary to administer without any delay to control PCAR.

Original languageEnglish
Pages (from-to)1732-1738
Number of pages7
JournalTransplantation Proceedings
Volume51
Issue number6
DOIs
Publication statusPublished - 01-07-2019

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Plasma Cells
Transplants
Kidney
Plasma Exchange
Intravenous Immunoglobulins
Therapeutics
Antibodies
Biopsy
Passive Immunization
Antilymphocyte Serum
Bortezomib
Graft Survival
Kidney Transplantation
Renal Dialysis
Steroids
Rabbits
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

Cite this

Tasaki, M., Saito, K., Nakagawa, Y., Ikeda, M., Imai, N., Ito, Y., ... Tomita, Y. (2019). Bortezomib Eliminates Plasma Cells From a Renal Graft in Plasma Cell–Rich Acute Rejection. Transplantation Proceedings, 51(6), 1732-1738. https://doi.org/10.1016/j.transproceed.2019.02.038
Tasaki, Masayuki ; Saito, Kazuhide ; Nakagawa, Yuki ; Ikeda, Masahiro ; Imai, Naofumi ; Ito, Yumi ; Sudo, Masanori ; Ikezumi, Yohei ; Yamada, Takeshi ; Hasegawa, Hiroya ; Kobayashi, Takashi ; Miura, K. ; Narita, I. ; Takahashi, Kota ; Tomita, Yoshihiko. / Bortezomib Eliminates Plasma Cells From a Renal Graft in Plasma Cell–Rich Acute Rejection. In: Transplantation Proceedings. 2019 ; Vol. 51, No. 6. pp. 1732-1738.
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abstract = "Plasma cell–rich acute rejection (PCAR) and antibody-mediated rejection (ABMR), for which a standard treatment has not yet been established, are associated with poor graft survival after kidney transplantation. Here, we report a case series of 3 Japanese patients diagnosed with PCAR accompanied by ABMR. Steroid pulse therapy and rabbit antithymocyte globulin, plasma exchange, intravenous immunoglobulin, and rituximab therapies were sequentially performed in the first case. A graft biopsy after each treatment showed that plasma cell infiltration persisted. Five months after the initiation of rejection therapy, the patient was subjected to bortezomib therapy, which led to the partial elimination of plasma cells from the graft. However, the graft function gradually deteriorated, and hemodialysis treatment was warranted. In the other 2 cases, the patients received the same combination of therapy including bortezomib within a short period. Graft biopsies performed subsequently showed a marked decrease in the number of infiltrated plasma cells, and stabilization of renal graft function was achieved in both cases. Bortezomib, which targets plasma cells, is a potent drug that eliminates infiltrated plasma cells from the graft in PCAR. Thus, in addition to conventional therapy comprising plasma exchange, intravenous immunoglobulin, and rituximab against ABMR, bortezomib may be necessary to administer without any delay to control PCAR.",
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Tasaki, M, Saito, K, Nakagawa, Y, Ikeda, M, Imai, N, Ito, Y, Sudo, M, Ikezumi, Y, Yamada, T, Hasegawa, H, Kobayashi, T, Miura, K, Narita, I, Takahashi, K & Tomita, Y 2019, 'Bortezomib Eliminates Plasma Cells From a Renal Graft in Plasma Cell–Rich Acute Rejection', Transplantation Proceedings, vol. 51, no. 6, pp. 1732-1738. https://doi.org/10.1016/j.transproceed.2019.02.038

Bortezomib Eliminates Plasma Cells From a Renal Graft in Plasma Cell–Rich Acute Rejection. / Tasaki, Masayuki; Saito, Kazuhide; Nakagawa, Yuki; Ikeda, Masahiro; Imai, Naofumi; Ito, Yumi; Sudo, Masanori; Ikezumi, Yohei; Yamada, Takeshi; Hasegawa, Hiroya; Kobayashi, Takashi; Miura, K.; Narita, I.; Takahashi, Kota; Tomita, Yoshihiko.

In: Transplantation Proceedings, Vol. 51, No. 6, 01.07.2019, p. 1732-1738.

Research output: Contribution to journalArticle

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T1 - Bortezomib Eliminates Plasma Cells From a Renal Graft in Plasma Cell–Rich Acute Rejection

AU - Tasaki, Masayuki

AU - Saito, Kazuhide

AU - Nakagawa, Yuki

AU - Ikeda, Masahiro

AU - Imai, Naofumi

AU - Ito, Yumi

AU - Sudo, Masanori

AU - Ikezumi, Yohei

AU - Yamada, Takeshi

AU - Hasegawa, Hiroya

AU - Kobayashi, Takashi

AU - Miura, K.

AU - Narita, I.

AU - Takahashi, Kota

AU - Tomita, Yoshihiko

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Plasma cell–rich acute rejection (PCAR) and antibody-mediated rejection (ABMR), for which a standard treatment has not yet been established, are associated with poor graft survival after kidney transplantation. Here, we report a case series of 3 Japanese patients diagnosed with PCAR accompanied by ABMR. Steroid pulse therapy and rabbit antithymocyte globulin, plasma exchange, intravenous immunoglobulin, and rituximab therapies were sequentially performed in the first case. A graft biopsy after each treatment showed that plasma cell infiltration persisted. Five months after the initiation of rejection therapy, the patient was subjected to bortezomib therapy, which led to the partial elimination of plasma cells from the graft. However, the graft function gradually deteriorated, and hemodialysis treatment was warranted. In the other 2 cases, the patients received the same combination of therapy including bortezomib within a short period. Graft biopsies performed subsequently showed a marked decrease in the number of infiltrated plasma cells, and stabilization of renal graft function was achieved in both cases. Bortezomib, which targets plasma cells, is a potent drug that eliminates infiltrated plasma cells from the graft in PCAR. Thus, in addition to conventional therapy comprising plasma exchange, intravenous immunoglobulin, and rituximab against ABMR, bortezomib may be necessary to administer without any delay to control PCAR.

AB - Plasma cell–rich acute rejection (PCAR) and antibody-mediated rejection (ABMR), for which a standard treatment has not yet been established, are associated with poor graft survival after kidney transplantation. Here, we report a case series of 3 Japanese patients diagnosed with PCAR accompanied by ABMR. Steroid pulse therapy and rabbit antithymocyte globulin, plasma exchange, intravenous immunoglobulin, and rituximab therapies were sequentially performed in the first case. A graft biopsy after each treatment showed that plasma cell infiltration persisted. Five months after the initiation of rejection therapy, the patient was subjected to bortezomib therapy, which led to the partial elimination of plasma cells from the graft. However, the graft function gradually deteriorated, and hemodialysis treatment was warranted. In the other 2 cases, the patients received the same combination of therapy including bortezomib within a short period. Graft biopsies performed subsequently showed a marked decrease in the number of infiltrated plasma cells, and stabilization of renal graft function was achieved in both cases. Bortezomib, which targets plasma cells, is a potent drug that eliminates infiltrated plasma cells from the graft in PCAR. Thus, in addition to conventional therapy comprising plasma exchange, intravenous immunoglobulin, and rituximab against ABMR, bortezomib may be necessary to administer without any delay to control PCAR.

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