1
|
Yoon I, Kim HB, Cho J, Pak CJ, Suh HP, Jeon JY, Hong JP. Does Lymphovenous Anastomosis Effect Mammalian Target of Rapamycin Inhibitor-associated Lymphedema Patients? Arch Plast Surg 2024; 51:321-326. [PMID: 38737839 PMCID: PMC11081724 DOI: 10.1055/a-2201-5881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/23/2023] [Indexed: 05/14/2024] Open
Abstract
The mammalian target of rapamycin (mTOR) inhibitors are used to prevent organ transplant rejection and are preferred over other immunosuppressants due to its low nephrotoxicity. However, mTOR inhibitors have been associated with various adverse effects including lymphedema. Although rare in incidence, previously known treatments for mTOR inhibitor-induced lymphedema were limited to discontinuation of related drugs and complex disruptive therapy with variable results. In this article, three patients who developed lymphedema in their lower limbs after using mTOR inhibitors, including two bilateral and one unilateral case, were treated with physiologic surgery methods such as lymphovenous anastomosis (LVA) and lymph node transfer. The efficacy of the treatment was evaluated. In the three cases described, cessation of the drug did not lead to any reduction in edema. The use of LVA and lymph node transfer resulted in early reductions in volume but failed to sustain over time. All patients underwent secondary nonphysiologic surgery such as liposuction resulting in sustained improvement. This series presents the first physiologic approach to mTOR inhibitor-induced lymphedema. Although further study is warranted, the physiologic surgical options may have limited success and nonphysiologic options may offer better sustainable results.
Collapse
Affiliation(s)
- Inah Yoon
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Bae Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeongmok Cho
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Changsik John Pak
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunsuk Peter Suh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Pio Hong
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Zhang Z, Qiu T, Zhou J, Gong X, Yang K, Zhang X, Lan Y, Yang C, Zhou Z, Ji Y. Toxic effects of sirolimus and everolimus on the development and behavior of zebrafish embryos. Biomed Pharmacother 2023; 166:115397. [PMID: 37659200 DOI: 10.1016/j.biopha.2023.115397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/04/2023] Open
Abstract
Sirolimus and everolimus have been widely used in children. These mammalian target of rapamycin (mTOR) inhibitors have shown excellent efficacy not only in organ transplant patients as immunosuppressive agents but also in patients with some other diseases. However, whether mTOR inhibitors can affect the growth and development of children is of great concern. In this study, using zebrafish models, we discovered that sirolimus and everolimus could slow the development of zebrafish, affecting indicators such as survival, hatching, deformities, body length, and movement. In addition to these basic indicators, sirolimus and everolimus had certain slowing effects on the growth and development of the nervous system, blood vessels, and the immune system. These effects were dose dependent. When the drug concentration reached or exceeded 0.5 μM, the impacts of sirolimus and everolimus were very significant. More interestingly, the impact was transient. Over time, the various manifestations of experimental embryos gradually approached those of control embryos. We also compared the effects of sirolimus and everolimus on zebrafish, and we revealed that there was no significant difference between these drugs in terms of their effects. In summary, the dose of sirolimus and everolimus in children should be strictly controlled, and the drug concentration should be monitored over time. Otherwise, drug overdosing may have a certain impact on the growth and development of children.
Collapse
Affiliation(s)
- Zixin Zhang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Tong Qiu
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jiangyuan Zhou
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xue Gong
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Kaiying Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China; Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, National Children's Medical Center for South Central Region, Guangzhou Medical University, Guangzhou 510623, China
| | - Xuepeng Zhang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yuru Lan
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Congxia Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zilong Zhou
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
| |
Collapse
|
3
|
Jaiswal LS, Sah B, Neupane A, Regmi N, Koirala D. Chronic lymphedema reversal following arteriovenous fistula takedown: A case report. Int J Surg Case Rep 2023; 109:108519. [PMID: 37499352 PMCID: PMC10413064 DOI: 10.1016/j.ijscr.2023.108519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/09/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Lymphedema is a very rare complication of Arteriovenous Fistula. The commonly encountered complications following the arteriovenous fistula are thrombosis, stenosis, congestive heart failure, ischemic neuropathy, steal syndrome, aneurysm and infection. Hence, presence of Lymphedema is a rarity that must be managed vigilantly. The incidence of lymphedema following AV fistula is very rare. Presently there is lack of studies evaluating the outcome of fistula take down. The standard care for lymphedema is complex decongestive physiotherapy in most of other causes bur Fistula Take down also helps in reducing the swelling in our case. CASE PRESENTATION Our case is of 53 years female presented to the surgical OPD with left upper limb swelling 5 months back which was non-pitting in nature. She was a known case of Acute kidney injury with no history of other comorbidities. The swelling started about 1 year ago involving the upper parts of the left arm which was intermittent and relieved spontaneously. She has a history of brachiocephalic fistula insertion for hemodialysis access 4 years ago with diagnosis of Acute Kidney Injury. However, the fistula was never used because of patient recovering from medical management. Investigations performed were doppler and other routine tests. CLINICAL DISCUSSION The fistula was patent on examination confirmed by venous hum on auscultation. Fistula takedown surgery was planned after ruling out thrombosis and stenosis using doppler. Other alternatives were not considered because of lack of use of fistula. The swelling started to improve postoperatively and the patient was discharged. CONCLUSION Our Case report highlights the fact that the rare complication like lymphedema could occur after the arteriovenous fistula which could be managed by fistula take down surgery if the fistula is no longer in use. Though very rare lymphedema should be kept in differential for complication which can be diagnosed by examination and ruling out other causes.
Collapse
Affiliation(s)
| | - Bijay Sah
- B.P. Koirala Institute of Health Sciences, Nepal
| | | | - Nakul Regmi
- B.P. Koirala Institute of Health Sciences, Nepal
| | | |
Collapse
|
4
|
Saygili Demir C, Sabine A, Gong M, Dormond O, Petrova TV. Mechanosensitive mTORC1 signaling maintains lymphatic valves. J Cell Biol 2023; 222:e202207049. [PMID: 37036444 PMCID: PMC10097975 DOI: 10.1083/jcb.202207049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/26/2023] [Accepted: 03/23/2023] [Indexed: 04/11/2023] Open
Abstract
Homeostatic maintenance and repair of lymphatic vessels are essential for health. We investigated the dynamics and the molecular mechanisms of lymphatic endothelial cell (LEC) renewal in adult mesenteric quiescent lymphatic vasculature using label-retention, lineage tracing, and cell ablation strategies. Unlike during development, adult LEC turnover and proliferation was confined to the valve regions of collecting vessels, with valve cells displaying the shortest lifespan. Proliferating valve sinus LECs were the main source for maintenance and repair of lymphatic valves. We identified mechanistic target of rapamycin complex 1 (mTORC1) as a mechanoresponsive pathway activated by fluid shear stress in LECs. Depending on the shear stress level, mTORC1 activity drives division of valve cells or dictates their mechanic resilience through increased protein synthesis. Overactivation of lymphatic mTORC1 in vivo promoted supernumerary valve formation. Our work provides insights into the molecular mechanisms of maintenance of healthy lymphatic vascular system.
Collapse
Affiliation(s)
- Cansaran Saygili Demir
- Department of Oncology, Lausanne University Hospital-University of Lausanne, Lausanne, Switzerland
- Ludwig Institute for Cancer Research Lausanne, Lausanne, Switzerland
| | - Amélie Sabine
- Department of Oncology, Lausanne University Hospital-University of Lausanne, Lausanne, Switzerland
- Ludwig Institute for Cancer Research Lausanne, Lausanne, Switzerland
| | - Muyun Gong
- Department of Oncology, Lausanne University Hospital-University of Lausanne, Lausanne, Switzerland
- Ludwig Institute for Cancer Research Lausanne, Lausanne, Switzerland
| | - Olivier Dormond
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Tatiana V. Petrova
- Department of Oncology, Lausanne University Hospital-University of Lausanne, Lausanne, Switzerland
- Ludwig Institute for Cancer Research Lausanne, Lausanne, Switzerland
- Swiss Institute for Experimental Cancer Research, École polytechnique fédérale de Lausanne, Lausanne, Switzerland
| |
Collapse
|
5
|
Vignes S. Genital Lymphedema after Cancer Treatment: A Narrative Review. Cancers (Basel) 2022; 14:cancers14235809. [PMID: 36497291 PMCID: PMC9739141 DOI: 10.3390/cancers14235809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Genital lymphedema may affect males and females after cancer treatment (gynecological, such as cervical, uterine or ovarian, melanoma, prostate, anus…). It is frequently associated with lower limb lymphedema, and is responsible for discomfort, cosmetic disfigurement and functional disturbances. Impacts on body image, sexual function and quality of life are major, and difficult to explore because cancer treatment itself and lymphedema are so closely interwoven. Local complications, e.g., papillomatosis, warty growth, lymph vesicles with embarrassing lymph oozing and cellulitis, may occur. Usual lymphedema therapies, like bandaging and elastic compression, are poorly adapted to these sites. Surgery, essentially based on cutaneous resection techniques, is the primary symptomatic treatment; it achieves good efficacy, in adults and children, with possible recurrence requiring reintervention.
Collapse
Affiliation(s)
- Stéphane Vignes
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (Lymphoedèmes Primaires), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| |
Collapse
|
6
|
Pateva I, Greene AK, Snyder KM. How we approach lymphedema in the pediatric population. Pediatr Blood Cancer 2022; 69 Suppl 3:e29908. [PMID: 36070213 DOI: 10.1002/pbc.29908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/05/2022]
Abstract
Lymphedema in children is rare; however, it is usually a progressive and chronic condition. Accurate diagnosis of lymphedema in the pediatric population often takes several months and sometimes is delayed for years. Lymphedema can be isolated or associated with genetic syndromes, thus it is very important to identify the correct diagnosis, to select carefully which patients to refer for genetic testing, and to initiate appropriate treatment in a timely fashion. In this article, we review key information about diagnosis of lymphedema, associated conditions and syndromes, and current treatment modalities.
Collapse
Affiliation(s)
- Irina Pateva
- Pediatric Hematology/Oncology, Rainbow Babies and Children's Hospital, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kristen M Snyder
- Comprehensive Vascular Anomalies Program, Solid Tumor Program, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Pateva I, Greene AK, Snyder KM. How we approach lymphedema in the pediatric population. Pediatr Blood Cancer 2022; 69:e29611. [PMID: 35404535 DOI: 10.1002/pbc.29611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/10/2022]
Abstract
Lymphedema in children is rare; however, it is usually a progressive and chronic condition. Accurate diagnosis of lymphedema in the pediatric population often takes several months and sometimes is delayed for years. Lymphedema can be isolated or associated with genetic syndromes, thus it is very important to identify the correct diagnosis, to select carefully which patients to refer for genetic testing, and to initiate appropriate treatment in a timely fashion. In this article, we review key information about diagnosis of lymphedema, associated conditions and syndromes, and current treatment modalities.
Collapse
Affiliation(s)
- Irina Pateva
- Pediatric Hematology/Oncology, Rainbow Babies and Children's Hospital, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kristen M Snyder
- Comprehensive Vascular Anomalies Program, Solid Tumor Program, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
8
|
Léauté-Labrèze C. Medical management of vascular anomalies of the head and neck. J Oral Pathol Med 2022; 51:837-843. [PMID: 35668029 PMCID: PMC10087965 DOI: 10.1111/jop.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
Depending on impairment, treatment of vascular anomalies is decided on a case-by-case basis in pluridisciplinary consultations. Interventional treatments, especially surgery and sclerotherapy, are usually partially efficient and management of patients with vascular anomalies increasingly involves the use of medical drugs. The most common vascular tumor is infantile hemangioma where first-line medical treatment, when necessary, is propranolol. Kasabach-Merritt phenomenon is now largely treated with sirolimus whereas first-line treatment of coagulation disorders associated with venous malformations is based on low molecular weight heparins or direct anticoagulants. Sirolimus is the standard treatment for painful inflammatory manifestations of low-flow vascular malformations such capillary, venous, and lymphatic malformations that can occur singly or in combination but PIK3CA inhibitors, originally developed in oncology, have shown promising results in patients with PIK3CA-related overgrowth spectrum. Currently, medical treatments are poorly developed for high-flow malformations such as arteriovenous malformations. However, new research aimed at delineating the different arteriovenous malformations based on molecular findings has given new hope for future development of targeted therapies.
Collapse
Affiliation(s)
- Christine Léauté-Labrèze
- Unité de Dermatologie Pédiatrique et Centre de Référence des Maladies Rares de la Peau d'Origine Génétique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux cedex, France
| |
Collapse
|
9
|
Landh E, Wang R, Moir LM, Traini D, Young PM, Ong HX. Prospective nanoparticle treatments for lymphangioleiomyomatosis. Expert Opin Drug Deliv 2022; 19:75-86. [DOI: 10.1080/17425247.2022.2029401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Emelie Landh
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia
- Discipline of Pharmacology, Faculty of Medicine and Health, Sydney, Australia
| | - Roger Wang
- Discipline of Pharmacology, Faculty of Medicine and Health, Sydney, Australia
| | - Lyn M. Moir
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia
- Discipline of Pharmacology, Faculty of Medicine and Health, Sydney, Australia
| | - Daniela Traini
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia
- Discipline of Pharmacology, Faculty of Medicine and Health, Sydney, Australia
| | - Paul M. Young
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia
- Discipline of Pharmacology, Faculty of Medicine and Health, Sydney, Australia
| | - Hui Xin Ong
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia
- Discipline of Pharmacology, Faculty of Medicine and Health, Sydney, Australia
| |
Collapse
|
10
|
Aksoyler D, Bitik O, Menku Ozdemir FD, Gokoz O, Uzun H, Yeniceri B, Nasir SN. A New Experimental Lymphedema Model: Reevaluating the Efficacy of Rat Models and Their Clinical Translation for Chronic Lymphedema Studies. Ann Plast Surg 2021; 86:707-713. [PMID: 32759623 DOI: 10.1097/sap.0000000000002479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our aim was to create a new rodent hind limb lymphedema model lacking the fibrosis effect induced by radiotherapy and subjected to the inhibition of lymphangiogenesis via sirolimus (rapamycin) to maintain a chronic lymphedema model and investigate its reliability for human treatment modalities. METHODS Forty-two Sprague-Dawley rats were randomly assigned to 7 groups: (1) surgery control, (2) vehicle-surgery control, (3) vehicle control, (4) rapamycin control, (5) surgery with 1 mg/kg per day rapamycin, (6) surgery with 1.5 mg/kg per day rapamycin, and (7) surgery with 2 mg/kg per day rapamycin. All surgeries were performed on the right hind limbs, with the left hind limbs also considered as a control. The drug and its solvent were administered daily into the relevant groups intraperiteonally. The presence of lymphedema was investigated by weekly limb circumference measurements, microcomputed tomography, fluorescence lymphography using indocyanine green dye, and microscopic evaluation at the end of the sixth week to determine any histological changes in the hind limbs. RESULTS In group 1, lymphedema was observed for 2 weeks (P = 0.032), whereas in groups 5, 6, and 7, lymphedema lasted for 3 weeks (P < 0.05.) Fluorescence using indocyanine green revealed that the edema was totally resolved after 6 weeks of surgery by a well-developed superficial lymphatic organization instead of the normal distinct vessel structure. Histologically, groups 1, 5, 5, and 7 demonstrated a significant increase in both the number of macrophages (P < 0.001) and newly formed lymphatic vessels in the right side surgically treated hind limb (P < 0.05). CONCLUSIONS Despite the extreme surgical destruction and lymphangiogenesis inhibition in the rat model, the sustained lymphedema did not last >3 weeks. Because of the rapid neolymphangiogenesis in murines and a different wound healing mechanism, they should not be considered as an appropriate model for research on human lymphedema in first place.
Collapse
Affiliation(s)
| | | | | | - Ozay Gokoz
- Department of Pathology, Hacettepe University Faculty of Medicine
| | - Hakan Uzun
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine
| | - Berna Yeniceri
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serdar Nazif Nasir
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine
| |
Collapse
|
11
|
Kim J, Jeon JY, Ko YM, Kang MS, Park SK, Roh K. Characteristics of Lymphedema in Patients Treated with Mammalian Target of Rapamycin Inhibitors. Lymphat Res Biol 2021; 19:365-371. [PMID: 33404372 DOI: 10.1089/lrb.2020.0069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose: To investigate the characteristics of lymphedema in patients treated with mammalian target of rapamycin (mTOR) inhibitors and delineate complex decongestive therapy (CDT) outcomes. Methods and Results: We retrospectively analyzed 24 patients with mTOR inhibitor-induced lymphedema and 7 lymphedema patients (control) not treated with mTOR inhibitors, who visited the lymphedema clinic of the department of rehabilitation medicine from March 2016 to December 2019. We comprehensively reviewed clinical features, medication history, associated diseases, lymphoscintigraphy, lower extremity computed tomography venography (LE CTV), and the effect of CDT. By using ImageJ program, we measured the cross-sectional area (CSA) of muscle and subcutaneous fat of mid-thigh image in LE CTV and compared them to a control group not treated with mTOR inhibitors. Seventeen patients on sirolimus and seven patients on everolimus were included, with an approximately equal distribution of stages 2 and 3 lymphedema, and most with pitting edema. Ten patients had breast or gynecological cancer and underwent lymph node dissection. Lymphedema developed after mTOR inhibitor initiation, not postoperatively. Lymphoscintigraphy revealed decreased lymph node uptake and dermal backflow. LE CTV revealed subcutaneous honeycomb-shaped trabecular areas in the affected limbs of seven patients. Patients treated with mTOR inhibitors had a larger mean subcutaneous fat CSA and a smaller mean muscular CSA than controls. Lymphedema improved or remained unchanged after initial CDT. Daily CDT adequately controlled 11 cases, but exacerbation occurred in 5 of 7 poorly compliant patients, and cellulitis occurred in 6 patients. Conclusion: Physicians should identify mTOR inhibitor-related lymphedema early and discuss medication alternatives and CDT with patients.
Collapse
Affiliation(s)
- JaYoung Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Ko
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Soo Kang
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su-Kil Park
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea
| | - Kangsan Roh
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Borman P, Yaman A, Denizli M. Upper Extremity Lymphedema Related to Everolimus in a Renal Transplant Recipient: Efficacy of Complete Decongestive Therapy. EXP CLIN TRANSPLANT 2020; 20:698-701. [PMID: 33272155 DOI: 10.6002/ect.2020.0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report our experience with a new case of lymphedema of the upper extremity in a renal transplant recipient under treatment with everolimus immunosuppression, and we emphasize the effects of complete decongestive therapy on this chronic condition.
Collapse
Affiliation(s)
- Pınar Borman
- From the University of Kastamonu Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kastamonu, Turkey.,From the Ankara City Hospital Department of Physical Medicine and Rehabilitation, Bilkent, Ankara, Turkey
| | | | | |
Collapse
|
13
|
Ji Y, Chen S, Xia C, Zhou J, Jiang X, Xu X, Yang K, Zhang X, Kong F, Lu G, Zhang Y. Chronic lymphedema in patients with kaposiform hemangioendothelioma: incidence, clinical features, risk factors and management. Orphanet J Rare Dis 2020; 15:313. [PMID: 33160383 PMCID: PMC7648422 DOI: 10.1186/s13023-020-01595-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/26/2020] [Indexed: 02/08/2023] Open
Abstract
Objectives There are no cohort studies of chronic lymphedema in patients with kaposiform hemangioendothelioma (KHE). We sought to characterize the incidence, clinical features, risk factors and management of chronic lymphedema in patients with KHE. Methods We conducted a multicenter retrospective analysis of patients who had a minimum of 3 years of follow-up after the onset of KHE and/or Kasabach–Merritt phenomenon (KMP). Clinical features were reviewed to determine the possible cause of chronic lymphedema. The degree of lymphedema, risk factors and management strategies were analyzed. Results Among the 118 patients, chronic lymphedema was confirmed by lymphoscintigraphy 1 year after the onset of KHE and/or KMP in 13 patients. In 8 patients with lymphedema, extremity swelling was evident in the presence of KHE and/or KMP. In all patients with lymphedema, a unilateral extremity was affected, along with ipsilateral KHE. Most (84.6%) patients reported moderate lymphedema. Lymphedema was more common in patients with larger (≥ 10 cm) and mixed lesions involving the extremities (P < 0.01). A history of KMP and sirolimus treatment were not predictors of lymphedema (P > 0.05). Overall, 76.9% of patients received sirolimus treatment after referral, including 53.8% who presented extremity swelling before referral. Seven (53.8%) patients received compression therapy. Five (38.5%) patients reported lymphedema-associated decreased range of motion at the last follow-up. Conclusions Chronic lymphedema is a common sequela of KHE and can occur independently of KMP and sirolimus treatment. Patients with large and mixed KHE involving extremities should be closely monitored for this disabling complication.
Collapse
Affiliation(s)
- Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China.
| | - Chuncao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jiangyuan Zhou
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xuewen Xu
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Kaiying Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xuepeng Zhang
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China
| | - Feiteng Kong
- Department of Pediatric Surgery, Sichuan Women and Children's Hospital, Chengdu, 610045, China
| | - Guoyan Lu
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Yongbo Zhang
- Department of Pediatric Surgery, Chengdu Women and Children's Central Hospital, Chengdu, 610031, China
| |
Collapse
|
14
|
Halamkova J, Kazda T, Adamkova-Krakorova D, Rybnickova S, Kiss I, Demlova R. Everolimus-related unilateral abdominal lymphedema in a renal cancer patient: A case report. Medicine (Baltimore) 2020; 99:e22634. [PMID: 33080700 PMCID: PMC7571978 DOI: 10.1097/md.0000000000022634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Unilateral manifestation of lymphedema during everolimus therapy has been described only rarely, mostly in transplant recipients. PATIENT CONCERNS We report the first case of a patient who developed unilateral abdominal lymphedema, during a short period of everolimus treatment for renal cancer. DIAGNOSIS The abdominal asymmetry occurred only on the right side of the abdomen, neither ultrasound nor CT scan detected ascites but showed enlargement of the abdominal wall. The Naranjo Adverse Drug Reaction Probability scale was evaluated, in this case, a score of 6 indicated a probable adverse reaction to everolimus. INTERVENTIONS Discontinuation of everolimus therapy led to immediate alleviation and reduction of the lymphedema, with worsening once again after initiating retreatment with everolimus at a reduced dose. OUTCOMES The patient's lymphedema recovered after discontinuation of everolimus. LESSONS This rare case demonstrates the importance of the selection of mammalian target of rapamycin inhibitors using caution, especially for patients with a high risk of developing lymphedema.
Collapse
Affiliation(s)
- Jana Halamkova
- Department of Cancer Comprehensive Care, Masaryk Memorial Cancer Institute, Faculty of Medicine Masaryk University
- Department of Medical Ethics, Faculty of Medicine, Masaryk University
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Faculty of Medicine Masaryk University
| | | | | | - Igor Kiss
- Department of Cancer Comprehensive Care, Masaryk Memorial Cancer Institute, Faculty of Medicine Masaryk University
| | - Regina Demlova
- Clinical Trial Unit, Masaryk Memorial Cancer Institute
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| |
Collapse
|
15
|
Landh E, M Moir L, Bradbury P, Traini D, M Young P, Ong HX. Properties of rapamycin solid lipid nanoparticles for lymphatic access through the lungs & part I: the effect of size. Nanomedicine (Lond) 2020; 15:1927-1945. [PMID: 32820673 DOI: 10.2217/nnm-2020-0077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Lymphangioleiomyomatosis (LAM) is characterized by growth of smooth muscle-like cells in the lungs that spread to other organs via lymphatic vessels. Current oral rapamycin treatment is limited by low bioavailability of approximately 15%. Aim: The effect of inhaled rapamycin solid lipid nanoparticles (Rapa-SLNs) size on its penetration through the lymphatics. Method: Three Rapa-SLN formulations (200-1000 nm) were produced and assessed for particle characteristics and further for toxicity and performance in vitro. Results: Rapa-SLNs of 200 nm inhibited proliferation in TSC2-negative mouse embryonic fibroblast cells and penetrated the respiratory epithelium and lymphatic endothelium significantly faster compared with free rapamycin and larger Rapa-SLNs. Conclusion: Rapa-SLN approximately 200 nm allows efficient entry of rapamycin into the lymphatic system and is therefore a promising treatment for LAM patients.
Collapse
Affiliation(s)
- Emelie Landh
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.,Discipline of Pharmacology, Faculty of Medicine & Health, Sydney, 2006, Australia
| | - Lyn M Moir
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.,Discipline of Pharmacology, Faculty of Medicine & Health, Sydney, 2006, Australia
| | - Peta Bradbury
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia
| | - Daniela Traini
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.,Discipline of Pharmacology, Faculty of Medicine & Health, Sydney, 2006, Australia
| | - Paul M Young
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.,Discipline of Pharmacology, Faculty of Medicine & Health, Sydney, 2006, Australia
| | - Hui Xin Ong
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.,Discipline of Pharmacology, Faculty of Medicine & Health, Sydney, 2006, Australia
| |
Collapse
|
16
|
Landh E, Moir LM, Traini D, Young PM, Ong HX. Properties of rapamycin solid lipid nanoparticles for lymphatic access through the lungs & part II: the effect of nanoparticle charge. Nanomedicine (Lond) 2020; 15:1947-1963. [PMID: 32812483 DOI: 10.2217/nnm-2020-0192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: Lymphangioleiomyomatosis is characterized by smooth muscle-like cells in the lungs that spread to other organs via lymphatic vessels. Oral rapamycin is restricted by low bioavailability approximately 15%. The aim of the present study is to systematically investigate the effect of inhaled rapamycin solid lipid nanoparticles (Rapa-SLN) surface charge on efficacy and penetration into the lymphatics. Materials & methods: Rapa-SLN formulations with different charge: neutral, positive and negative, were produced and assessed for their physicochemical particle characteristics and efficacy in vitro. Results: Negative Rapa-SLNs were significantly faster at entering the lymphatic endothelium and more potent at inhibiting lymphanigiogenesis compared with neutral and positive Rapa-SLNs. Conclusion: Negative Rapa-SLNs showed efficient lymphatic access and should therefore be investigated further as a treatment for targeting extrapulmonary lymphangioleiomyomatosis.
Collapse
Affiliation(s)
- Emelie Landh
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.,Discipline of Pharmacology, Faculty of Medicine & Health, Sydney, NSW, 2006, Australia
| | - Lyn M Moir
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.,Discipline of Pharmacology, Faculty of Medicine & Health, Sydney, NSW, 2006, Australia
| | - Daniela Traini
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.,Discipline of Pharmacology, Faculty of Medicine & Health, Sydney, NSW, 2006, Australia
| | - Paul M Young
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.,Discipline of Pharmacology, Faculty of Medicine & Health, Sydney, NSW, 2006, Australia
| | - Hui X Ong
- Respiratory Technology, Woolcock Institute of Medical Research, Glebe, NSW, 2037, Australia.,Discipline of Pharmacology, Faculty of Medicine & Health, Sydney, NSW, 2006, Australia
| |
Collapse
|
17
|
Sirolimus and mTOR Inhibitors: A Review of Side Effects and Specific Management in Solid Organ Transplantation. Drug Saf 2020; 42:813-825. [PMID: 30868436 DOI: 10.1007/s40264-019-00810-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inhibitors of mechanistic target of rapamycin (mTOR inhibitors) are used as antiproliferative immunosuppressive drugs and have many clinical applications in various drug combinations. Experience in transplantation studies has been gained regarding the side effect profile of these drugs and the potential benefits and limitations compared with other immunosuppressive agents. This article reviews the adverse effects of mTOR inhibitors in solid organ transplantation, with special attention given to mechanisms hypothesized to cause adverse events and their management strategies.
Collapse
|
18
|
Inhaled rapamycin solid lipid nano particles for the treatment of Lymphangioleiomyomatosis. Eur J Pharm Sci 2020; 142:105098. [DOI: 10.1016/j.ejps.2019.105098] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 01/03/2023]
|
19
|
Leducq S, Caille A, Barbarot S, Bénéton N, Bessis D, Boccara O, Bursztejn AC, Chiaverini C, Dompmartin A, Droitcourt C, Gissot V, Goga D, Guibaud L, Herbreteau D, Le Touze A, Léauté-Labrèze C, Lorette G, Mallet S, Martin L, Mazereeuw-Hautier J, Phan A, Plantin P, Quéré I, Vabres P, Bourgoin H, Giraudeau B, Maruani A. Topical sirolimus 0.1% for treating cutaneous microcystic lymphatic malformations in children and adults (TOPICAL): protocol for a multicenter phase 2, within-person, randomized, double-blind, vehicle-controlled clinical trial. Trials 2019; 20:739. [PMID: 31847908 PMCID: PMC6918625 DOI: 10.1186/s13063-019-3767-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Cutaneous microcystic lymphatic malformations (CMLMs) are rare conditions in children and adults. They present as clusters of vesicles full of lymph and blood to various extents, inducing maceration, esthetic impairment, pain, and impaired quality of life. The treatment is challenging. Sirolimus is an inhibitor of mammalian target of rapamycin (mTOR) involved in angio-lymphangiogenesis. Topical sirolimus has recently been reported as effective in a few reports of patients with CMLMs. The objective is to compare the efficacy and safety of a 12-week application of 0.1% topical sirolimus versus topical vehicle in CMLMs in children and adults. Methods This French blinded multicenter within-person randomized controlled phase 2 trial aims to include 55 patients aged ≥ 6 years who have a primary CMLM. The CMLM will be divided into two equal areas that will be randomly allocated to 0.1% topical sirolimus or topical vehicle applied for 12 weeks. At the end of the 12-week period, the patient/parent will treat the whole area of CMLM with 0.1% topical sirolimus on remaining lesions, for eight more weeks. Patients will be seen at week 20 (treatment will be stopped) and at month 12 to evaluate long-term efficacy. The primary outcome will be improvement of the CMLM in the area treated with topical sirolimus compared to the area treated with topical vehicle by the investigator physician (blinded to the treatment) with the Physician Global Assessment score at week 12. Secondary outcomes will include: assessment of efficacy by independent experts on the basis of standardized photographs; impact on quality of life; efficacy for oozing, bleeding, erythema, and thickness evaluated by the investigators; and global efficacy as well as efficacy for functional and aesthetic impairment evaluated by the patient. Systemic passage of sirolimus will be measured at weeks 6, 12, and 20, and at week 16 for CMLMs ≥ 900 cm2. Discussion For patients with CMLMs, topical sirolimus could be a non-invasive and well-tolerated therapeutic option. If the trial demonstrates efficacy and safety of this treatment, this result will lead to a real change in the management of this condition, and 0.1% sirolimus cream would become the first-line treatment. Trial registration ClinicalTrials.gov, NCT03972592. Registered on 3 June 2019. EU Clinical Trials Register EudraCT, 2018–001359-11.
Collapse
Affiliation(s)
- Sophie Leducq
- INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France. .,Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France. .,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.
| | - Agnès Caille
- INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France.,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France
| | - Sébastien Barbarot
- Department of Dermatology, University Hospital Center of Nantes, 44000, Nantes, France
| | - Nathalie Bénéton
- Department of Dermatology, Hospital Center of le Mans, 72037, le Mans, France
| | - Didier Bessis
- Department of Dermatology, University Hospital Center of Montpellier, 34000, Montpellier, France
| | - Olivia Boccara
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC), University Hospital Necker-Enfants Malades, 75015, Paris, France
| | - Anne-Claire Bursztejn
- Department of Dermatology, University Hospital Center of Nancy, 54000, Nancy, France
| | - Christine Chiaverini
- Department of Dermatology, University Hospital Center of Nice, 06000, Nice, France
| | - Anne Dompmartin
- Department of Dermatology, University Hospital Center of Caen, 54000, Caen, France
| | - Catherine Droitcourt
- Department of Dermatology, University Hospital Center of Rennes, 35000, Rennes, France
| | - Valérie Gissot
- Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France
| | - Dominique Goga
- Department of Maxillo-Facial surgery, CHRU Tours, 37044, Tours, Cedex 9, France
| | - Laurent Guibaud
- University Hospital Center of Lyon, Consultation Multidisciplinaire Lyonnaise des Angiomes, 69229, Lyon, Cedex 2, France
| | | | - Anne Le Touze
- Department of Pediatric Surgery, CHRU Tours, 37000, Tours, France
| | | | - Gérard Lorette
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France
| | - Stéphanie Mallet
- Department of Dermatology, University Hospital Center of Marseille, 13885, Marseille, Cedex 5, France
| | - Ludovic Martin
- Department of Dermatology, University Hospital Center of Angers, 49000, Angers, France
| | - Juliette Mazereeuw-Hautier
- Reference center for rare skin diseases, Department of Dermatology, University Hospital Center of Toulouse, Paul Sabatier University, 31059, Toulouse, France
| | - Alice Phan
- Department of Dermatology, University Hospital Center of Lyon, 69229, Lyon, Cedex 2, France
| | - Patrice Plantin
- Department of Dermatology, Hospital Center of Quimper, 29107, Quimper, France
| | - Isabelle Quéré
- Departement of Vascular Medicine, National Reference Centre for Rare Vascular Diseases, EA 2992 Research Team, University of Montpellier, University Hospital Center of Montpellier, 34000, Montpellier, France
| | - Pierre Vabres
- Department of Dermatology, University Hospital Center of Dijon, 21000, Dijon, France
| | - Hélène Bourgoin
- Department of Pharmacy, University Hospital Center of Tours, 37000, Tours, France
| | - Bruno Giraudeau
- INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France.,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France
| | - Annabel Maruani
- INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France. .,Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France. .,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.
| | | |
Collapse
|
20
|
Noncontrast Magnetic Resonance Lymphangiography in a Rare Case of Everolimus-Related Lymphedema. Ann Plast Surg 2019; 84:113-116. [DOI: 10.1097/sap.0000000000002055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Daniell KM, Bardia A, Sun F, Roberts SA, Brunelle CL, Gillespie TC, Sayegh HE, Naoum GE, Juric D, Isakoff SJ, Fitzgerald DM, Taghian AG. Incidence of peripheral edema in patients receiving PI3K/mTOR/CDK4/6 inhibitors for metastatic breast cancer. Breast Cancer Res Treat 2019; 175:649-658. [DOI: 10.1007/s10549-019-05206-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
|
22
|
Fourgeaud C, Simon L, Benoughidane B, Vignes S. Lymphœdèmes associés à la prise de sirolimus : à propos de 15 patients. Rev Med Interne 2019; 40:151-157. [DOI: 10.1016/j.revmed.2018.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/08/2018] [Accepted: 04/17/2018] [Indexed: 11/24/2022]
|
23
|
Anomalies vasculaires bénignes agressives de l’enfant et de l’adolescent. Bull Cancer 2018; 105:610-625. [DOI: 10.1016/j.bulcan.2018.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 01/11/2023]
|
24
|
Rashid-Farokhi F, Afshar H. Lymphedema of the Transplanted Kidney and Abdominal Wall with Ipsilateral Pleural Effusion Following Kidney Biopsy in a Patient Treated with Sirolimus: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1370-1376. [PMID: 29269724 PMCID: PMC5747954 DOI: 10.12659/ajcr.905962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/06/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor, which is used in immunosuppressive treatment regimens in organ transplant recipients. Although mTOR inhibitors are well tolerated, their adverse effects have been reported. Sirolimus treatment in transplant recipients has been reported to be associated with lymphedema of the skin and subcutaneous tissues, and with pleural effusion, but edema of internal organs and organomegaly have not been previously reported. A case is presented lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy in a patient treated with sirolimus. CASE REPORT A 32-year-old woman with a history of end-stage renal disease of unknown etiology had undergone right renal transplantation from an unrelated living donor, eight years previously. She was referred to our hospital with dyspnea, localized abdominal pain, and swelling of the transplanted kidney. The symptoms appeared following a kidney biopsy and the replacement of cyclosporin with sirolimus four months previously. On examination, she had localized swelling of the abdominal wall overlying the transplanted kidney, and a right pleural effusion. Hydronephrosis and nephrotic syndrome were excluded as causes of kidney enlargement. Following the withdrawal of sirolimus therapy her symptoms resolved within three months. CONCLUSIONS A case is described of lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy attributed to her change in anti-rejection therapy to sirolimus. This case report should raise awareness of this unusual complication of sirolimus anti-rejection therapy and its possible effects on the lymphatic system.
Collapse
Affiliation(s)
- Farin Rashid-Farokhi
- Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Nephrology, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Telemedicine Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hale Afshar
- Respiratory Disease Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
25
|
Kim YM, Moon C, Goo DE, Park SB, Park JW. Lymphedema secondary to idiopathic occlusion of the subclavian and innominate veins after renal transplantation: A case report. Medicine (Baltimore) 2017; 96:e8942. [PMID: 29310388 PMCID: PMC5728789 DOI: 10.1097/md.0000000000008942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Among the causes of swelling in the extremities of renal transplantation patients, secondary lymphedema caused by complete idiopathic obstruction of large veins is rare and may be difficult to diagnose and treat. PATIENT CONCERNS A 64-year-old man presented with severe edema and pain that occurred suddenly in the right arm. DIAGNOSES The patient was diagnosed as stage-2 secondary lymphedema caused by idiopathic occlusion of the subclavian and innominate veins. INTERVENTIONS Lymphoscintigraphy and ascending venography of the right arm confirmed the diagnosis. Intensive complete decongestive therapy for lymphedema was performed. OUTCOMES Following 2 weeks of active rehabilitation, the pain level and edema status were significantly improved. LESSONS When idiopathic swelling of the extremities occurs in renal transplant patients, secondary lymphedema caused by venous occlusion may be the cause. When direct intervention for the venous occlusion proves to be difficult, a conservative approach may be helpful.
Collapse
Affiliation(s)
- Yong Min Kim
- Department of Physical Medicine and Rehabilitation
| | | | - Dong Erk Goo
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Soo Bin Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | | |
Collapse
|
26
|
Hammill A, Mobberley-Schuman P, Adams D. Lymphoedema is a potential sequela of kaposiform haemangioendothelioma. Br J Dermatol 2016; 175:833-4. [PMID: 27291923 DOI: 10.1111/bjd.14810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Hammill
- Hemangioma and Vascular Malformations Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, U.S.A.
| | - P Mobberley-Schuman
- Hemangioma and Vascular Malformations Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, U.S.A
| | - D Adams
- Vascular Anomalies Center, Boston Children's Hospital, Boston, MA, U.S.A
| |
Collapse
|
27
|
Abstract
Lymphangioleiomyomatosis (LAM) is a rare neoplastic disease affecting predominantly young women. Clinical symptoms of this progressive disease include dyspnoea, cough, recurrent pneumothorax, hemoptysis and chylothorax. LAM is generally aggressive in nature and ultimately results in respiratory failure. Important hallmark features of this metastatic disease include the formation of lesions of abnormal smooth muscle cells, cystic destruction of the lung tissue and lymphangiogenesis affecting the lungs, abdomen and lymphatics. Research over the last 10-15 years has significantly enhanced our understanding of the molecular and cellular processes associated with LAM. These processes include mutational inactivation of the tuberous sclerosis complex genes, TSC1 and TSC2, activation of the mammalian target of rapamycin (mTOR) pathway, enhanced cell proliferation and migration, lymphangiogenesis, metastatic spread through the blood and lymphatic circulations, sex steroid sensitivity and dysregulated autophagy. Despite this increased knowledge there is currently no cure for LAM and treatment options remain limited. Whilst the mTOR inhibitor rapamycin has shown some benefit in patients with LAM, with stabilisation of lung function and improved quality of life, cessation of treatment results in recurrence of the disease progression. This highlights the urgent need to identify novel targets and new treatment regimens. The focus of this review is to summarise our current understanding of the cellular and molecular processes associated with LAM and highlight emerging treatments.
Collapse
Affiliation(s)
- Lyn M Moir
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Discipline of Pharmacology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
28
|
Thanaraj V, Woywodt A, Anderton J. A transplant patient with a swollen leg. Clin Kidney J 2015; 5:467-70. [PMID: 26019829 PMCID: PMC4432419 DOI: 10.1093/ckj/sfs109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/18/2012] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vijay Thanaraj
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
| | - Alex Woywodt
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
| | - John Anderton
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
| |
Collapse
|
29
|
Al Gain M, Crickx B, Bejar C, Chen L, Azeroual L, Marinho E, Descamps V. [Sirolimus-induced lymphedema in a kidney-transplant recipient: Partial recovery after changeover to tacrolimus]. Ann Dermatol Venereol 2015; 142:350-5. [PMID: 25683011 DOI: 10.1016/j.annder.2015.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/09/2014] [Accepted: 01/06/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lymphedema induced by mTOR inhibitors is a side-effect rarely reported to date. PATIENTS AND METHODS Long-lasting bilateral lower-limb lymphedema with left predominance developed in a 71-year-old stable renal transplant recipient after 40 months of sirolimus treatment. Although no change in lymphedema was observed after 21 months despite dosage reduced, it improved markedly after changeover to tacrolimus. DISCUSSION Regardless of the individual drug, mTOR inhibitors can cause lymphedema. This effect may be countered through substitution with tacrolimus. CONCLUSION Physicians should be aware of lymphedema as a side-effect of mTOR inhibitors. It can be improved by substitution with tacrolimus. However, early withdrawal of mTOR inhibitors is recommended before irreversible lymphedema occurs.
Collapse
Affiliation(s)
- M Al Gain
- Service de dermatologie, hôpital Bichat, APHP, université Paris-Diderot, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Service de dermatologie, King-Abdulaziz university, Jeddah, Arabie Saoudite
| | - B Crickx
- Service de dermatologie, hôpital Bichat, APHP, université Paris-Diderot, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - C Bejar
- Service de dermatologie, hôpital Bichat, APHP, université Paris-Diderot, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - L Chen
- Service de dermatologie, hôpital Bichat, APHP, université Paris-Diderot, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - L Azeroual
- Service de néphrologie, hôpital Bichat, APHP, université Paris-Diderot, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - E Marinho
- Service d'anatomopathologie, hôpital Bichat, APHP, université Paris-Diderot, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - V Descamps
- Service de dermatologie, hôpital Bichat, APHP, université Paris-Diderot, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
| |
Collapse
|
30
|
Chen JH, Chang CM, Lu MC, Wei CK, Yin WY. Delayed-Onset Chylous Ascites After a Living-Donor Liver Transplant: First Case Successfully Treated With Conservative Treatment? EXP CLIN TRANSPLANT 2014; 14:345-8. [PMID: 25365187 DOI: 10.6002/ect.2014.0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chylous ascites is a rare complication in liver transplant. Few cases have been reported to date. In most cases, chylous ascites is diagnosed within 1 month after surgery because of intraoperative injury of the hilar lymphatic system. Preoperative massive ascites and use of a LigaSure vessel sealing system for hilar dissection have been reported as risk factors. We report a case of chylous ascites after a living-donor liver transplant that was diagnosed after 6 months of uneventful follow-up. Sirolimus was added to cyclosporine early (2 wk after the operation) owing to poor renal function and it was found to be high (> 22 ng/mL) when the chylous ascites occurred. The patient was treated with total parenteral nutrition in combination with Sandostatin and rapid tapering of sirolimus after the failed initial conservative treatment. Residual abdominal fullness after meals and lymphedema of the legs disappeared 1 month after discontinuing sirolimus. This is the first case of delayed-onset chylous ascites after a liver transplant that was successfully treated conservatively.
Collapse
Affiliation(s)
- Jian-Han Chen
- From the Department of General Surgery, Dalin Tzu Chi General Hospital, Chia-I, Taiwan
| | | | | | | | | |
Collapse
|
31
|
Vignes S, Brunet M, Blanchard M, Smail A, Arrault M. Large-Volume Sirolimus-Induced Upper Limb Lymphedema after Renal Transplantation Ipsilateral to the Arteriovenous Fistula. Lymphat Res Biol 2014; 12:185-8. [DOI: 10.1089/lrb.2014.0005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Stéphane Vignes
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares, Hôpital Cognacq-Jay, Paris, France
| | - Morgan Brunet
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares, Hôpital Cognacq-Jay, Paris, France
| | - Marie Blanchard
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares, Hôpital Cognacq-Jay, Paris, France
| | - Amar Smail
- Department of Internal Medicine, CHU d'Amiens, Hôpital Nord, Amiens Cedex, France
| | - Maria Arrault
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares, Hôpital Cognacq-Jay, Paris, France
| |
Collapse
|
32
|
Doğan SM, Kılınç S, Kebapçı E, Tuğmen C, Gürkan A, Baran M, Kurtulmuş Y, Ölmez M, Karaca C. Mesenchymal stem cell therapy in patients with small bowel transplantation: Single center experience. World J Gastroenterol 2014; 20:8215-8220. [PMID: 25009395 PMCID: PMC4081695 DOI: 10.3748/wjg.v20.i25.8215] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/09/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the effects of mesenchymal stem cell (MSC) therapy on the prevention of acute rejection and graft vs host disease following small bowel transplantation.
METHODS: In our transplantation center, 6 isolated intestinal transplants have been performed with MSC therapy since 2009. The primary reasons for transplants were short gut syndrome caused by surgical intestine resection for superior mesenteric artery thrombosis (n = 4), Crohn’s disease (n = 1) and intestinal aganglionosis (n = 1). Two of the patients were children. At the time of reperfusion, the first dose of MSCs cultured from the patient’s bone marrow was passed into the transplanted intestinal artery at a dose of 1000000 cells/kg. The second and third doses of MSCs were given directly into the mesenteric artery through the arterial anastomosis using an angiography catheter on day 15 and 30 post-transplant.
RESULTS: The median follow-up for these patients was 10.6 mo (min: 2 mo-max: 30 mo). Three of the patients developed severe acute rejection. One of these patients did not respond to bolus steroid therapy. Although the other two patients did respond to anti-rejection treatment, they developed severe fungal and bacterial infections. All of these patients died in the 2nd and 3rd months post-transplant due to sepsis. The remaining patients who did not have acute rejection had good quality of life with no complications observed during the follow-up period. In addition, their intestinal grafts were functioning properly in the 13th, 25th and 30th month post-transplant. The patients who survived did not encounter any problems related to MSC transplantation.
CONCLUSION: Although this is a small case series and not a randomized study, it is our opinion that small bowel transplantation is an effective treatment for intestinal failure, and MSC therapy may help to prevent acute rejection and graft vs host disease following intestinal transplantation.
Collapse
|
33
|
Strategies for the management of adverse events associated with mTOR inhibitors. Transplant Rev (Orlando) 2014; 28:126-33. [PMID: 24685370 DOI: 10.1016/j.trre.2014.03.002] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/04/2014] [Accepted: 03/08/2014] [Indexed: 12/29/2022]
Abstract
Mammalian target of rapamycin (mTOR) inhibitors are used as potent immunosuppressive agents in solid-organ transplant recipients (everolimus and sirolimus) and as antineoplastic therapies for various cancers (eg, advanced renal cell carcinoma; everolimus, temsirolimus, ridaforolimus). Relevant literature, obtained from specific PubMed searches, was reviewed to evaluate the incidence and mechanistic features of specific adverse events (AEs) associated with mTOR inhibitor treatment, and to present strategies to effectively manage these events. The AEs examined in this review include stomatitis and other cutaneous AEs, wound-healing complications (eg, lymphocele, incisional hernia), diabetes/hyperglycemia, dyslipidemia, proteinuria, nephrotoxicity, delayed graft function, pneumonitis, anemia, hypertension, gonadal dysfunction, and ovarian toxicity. Strategies for selecting appropriate patients for mTOR inhibitor therapy and minimizing the risks of AEs are discussed, along with best practices for identifying and managing side effects. mTOR inhibitors are promising therapeutic options in immunosuppression and oncology; most AEs can be effectively detected and managed or reversed with careful monitoring and appropriate interventions.
Collapse
|
34
|
Liu LS, McNiff JM, Colegio OR. Palmoplantar peeling secondary to sirolimus therapy. Am J Transplant 2014; 14:221-5. [PMID: 24224736 PMCID: PMC4148300 DOI: 10.1111/ajt.12511] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/26/2013] [Accepted: 09/10/2013] [Indexed: 01/25/2023]
Abstract
Sirolimus (rapamycin) is an immunosuppressive agent commonly used in transplant recipients. Although sirolimus has less renal toxicity than calcineurin inhibitors, its use has been limited by its side effects. The most common cutaneous pathologies associated with sirolimus are inflammatory acneiform eruptions, lymphedema and aphthous ulcers. We present a novel cutaneous manifestation of sirolimus therapy that limited its use in at least one transplant recipient. Upon commencing sirolimus therapy, four solid organ transplant recipients developed tender, nonpruritic palmoplantar peeling within the first month of therapy. The peeling clinically resembled a mild form of hand-foot syndrome, yet none of the patients had been treated with chemotherapeutics. Desquamation presented on the palms and soles with dry vesicles and minor peeling extending to the dorsal aspects of the hands and feet. Histologically, the lesions were noninflammatory; the epidermis showed subtle separation between keratinocytes, suggesting either spongiosis or a defect in intercellular adhesion. One patient opted to discontinue treatment because of the tenderness associated with the palmoplantar peeling, which resulted in complete resolution within 2 weeks.
Collapse
Affiliation(s)
- L. S. Liu
- Yale Transplant Dermatology Clinic, Yale University School of Medicine, New Haven, CT
| | - J. M. McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, CT
| | - O. R. Colegio
- Yale Transplant Dermatology Clinic, Yale University School of Medicine, New Haven, CT,Yale-New Haven Transplantation Center, Yale University School of Medicine, New Haven, CT,Corresponding author: Oscar R. Colegio,
| |
Collapse
|
35
|
Özcan D, Seçkin D, Ada S, Haberal M. Mucocutaneous disorders in renal transplant recipients receiving sirolimus-based immunosuppressive therapy: a prospective, case-control study. Clin Transplant 2013; 27:742-8. [PMID: 23991694 DOI: 10.1111/ctr.12215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sirolimus (SRL) has some dermatologic complications including acneiform eruptions, edema, aphthous ulceration, and onychopathy. However, controlled studies reporting the prevalence and clinical characteristics of mucocutaneous disorders are scarce. OBJECTIVE To investigate the prevalence and clinical spectrum of mucocutaneous disorders in renal transplant recipients (RTRs) receiving SRL and to compare the findings with those in RTRs not receiving SRL. METHODS Fifty RTRs (35 men, 15 women; mean age, 34.6 ± 11.6 yr) receiving SRL, 50 RTRs (36 men, 14 women; mean age, 34.4 ± 11.3 yr) not on SRL were screened for mucocutaneous disorders. RESULTS In RTRs receiving SRL, skin infection (78%) was the most common dermatologic disorder followed by facial hyperpigmentation (50%) and acneiform eruption (46%). Herpes simplex virus infections (14%) and seborrheic dermatitis (38%) were significantly more common in RTRs on SRL (p < 0.05); the frequencies of edema, aphthous ulceration, acne, and longitudinal nail ridging were similar in both groups (p > 0.05). LIMITATIONS This study had a small sample size. The investigator was not blinded to immunosuppressive treatment protocols. CONCLUSION Renal transplant recipients receiving SRL are more likely to develop seborrheic dermatitis and herpes simplex virus infections than those not taking SRL. Whereas, they are not more prone to edema, aphthous ulceration, acne, or longitudinal nail ridging.
Collapse
Affiliation(s)
- Deren Özcan
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | | | | | | |
Collapse
|
36
|
Hille U, Soergel P, Makowski L, Dörk-Bousset T, Hillemanns P. Lymphedema of the breast as a symptom of internal diseases or side effect of mTor inhibitors. Lymphat Res Biol 2012; 10:63-73. [PMID: 22720661 DOI: 10.1089/lrb.2011.0025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A common situation presented in any clinical facility is a woman with swelling and redness of the breast. Diagnosis upon suspicion is often mastitis or inflammatory breast cancer, which are popular and well-known diseases of the breast. However, there is one main differential diagnosis which has to be taken into consideration: lymphedema of the breast. Twenty patients with internal diseases presented in our Breast Care Unit over a 4-year period with breast-affecting lymphedema. The patients suffered from cardiac failure, nephrotic syndrome, liver failure, lymphadenopathy, and central vein occlusion. Additionally, we identified 5 patients with a history of organ transplantation and under immunosupressive medication with sirolimus or everolimus. These mTor inhibitors are known to have unwanted side effects such as unilateral or bilateral upper/lower extremity peripheral edema or facial/eyelid edema, but as we know, isolated lymphedema of the breast represents a previously unreported complication.
Collapse
Affiliation(s)
- U Hille
- University Women's Hospital, Hannover Medical School, Hannover, Germany.
| | | | | | | | | |
Collapse
|
37
|
Witte MH, Dellinger MT, Papendieck CM, Boccardo F. Overlapping biomarkers, pathways, processes and syndromes in lymphatic development, growth and neoplasia. Clin Exp Metastasis 2012; 29:707-27. [PMID: 22798218 DOI: 10.1007/s10585-012-9493-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 05/20/2012] [Indexed: 12/19/2022]
Abstract
Recent discoveries in molecular lymphology, developmental biology, and tumor biology in the context of long-standing concepts and observations on development, growth, and neoplasia implicate overlapping pathways, processes, and clinical manifestations in developmental disorders and cancer metastasis. Highlighted in this review are some of what is known (and speculated) about the genes, proteins, and signaling pathways and processes involved in lymphatic/blood vascular development in comparison to those involved in cancer progression and spread. Clues and conundra from clinical disorders that mix these processes and mute them, including embryonic rests, multicentric nests of displaced cells, uncontrolled/invasive "benign" proliferation and lymphogenous/hematogenous "spread", represent a fine line between normal development and growth, dysplasia, benign and malignant neoplasia, and "metastasis". Improved understanding of these normal and pathologic processes and their underlying pathomechanisms, e.g., stem cell origin and bidirectional epithelial-mesenchymal transition, could lead to more successful approaches in classification, treatment, and even prevention of cancer and a whole host of other diseases.
Collapse
Affiliation(s)
- Marlys H Witte
- Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724-5200, USA.
| | | | | | | |
Collapse
|
38
|
Comparative analysis of adverse events requiring suspension of mTOR inhibitors: everolimus versus sirolimus. Transplant Proc 2011; 42:3050-2. [PMID: 20970607 DOI: 10.1016/j.transproceed.2010.07.083] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Inhibitors of mammalian target of rapamycin (mTORi) have been suggested as an alternative to calcineurin inhibitors (CNIs) to treat stable renal transplant recipients. However, their use has been significantly limited owing to a high incidence of side effects. OBJECTIVE To compare the rate of dropout (mTORi elimination and CNI reintroduction) caused by side effects among renal transplant patients converted to everolimus (EVL) or sirolimus (SRL). METHODS Between October 1999 and February 2010, 409 subjects were converted to an mTORi at least 3 months after transplantation, including 220 (53.8%) to EVL and 189 (46.2%) to SRL. Most patients were under CNI therapy. Patients were followed for a median of 35 months (interquartile range [IQR], 18-50 months). RESULTS mTORi treatment was prematurely eliminated due to adverse events in 112 patients. The median time between the initiation of mTORi and discontinuation was 5.7 months (IQR, 1.9-15.7 months; range, 0.2-48 months): 5.5 (IQR, 1.6-16.3) in the EVL group and 7.4 (IQR, 2.6-15.6) in the SRL group. In the EVL group, the drug was stopped in 69 patients (31.4%), and in the SRL group in 43 patients (22.8%; P=.051). The most important causes of discontinuation were severe infections (2.3% in EVL group and 4.8% in SRL group; P=.17), pneumonitis (6.8 % in EVL group and 4.8 in SRL group; P=.38), acute rejection episode (4.1% in EVL group and 1.6% in SRL group; P=.13), proteinuria (4.1% in EVL group and 1.6% in SRL group; P=.13), renal function deterioration (2.3% in EVL group and 2.1% in SRL group; P=.91), and severe dermal eruption (2.3% in EVL group and 0.5% in SRL group; P=.14). CONCLUSIONS Although the overall incidence discontinuations due to side effects was higher in the EVL group, there was no greater frequency of severe side effects, such as pneumonitis, proteinuria, acute rejection episodes, renal function deterioration, or dermal eruptions.
Collapse
|
39
|
Büchler M. L’utilisation des inhibiteurs de mTOR en transplantation rénale : pour quel malade et comment ? Nephrol Ther 2009; 5 Suppl 6:S390-4. [DOI: 10.1016/s1769-7255(09)73431-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|