Sirolimus to replace calcineurin inhibitors? Too early yet.

摘要

Replacement of ciclosporin and mycophenolate mofetil with sirolimus has been associated with regression of Kapo'si's sarcoma in renal transplant recipients on chronic immunosuppression. Disease development parallels reactivation of latent human herpesvirus 8 (HHV-8) or donor-to-recipienttransfer of HHV-8-infected progenitor cells. Patrizia Barozzi and colleagues1 recently reported nine patients with post-transplant Kaposi's sarcoma associated with a lack of HHV-8-specific T cells. In two patients who were switching from calcineurin inhibitors to sirolimus, disease recovery was paralleled by normalisation of the T-cell repertoire and recovery of both HHV-8 specific effector and memoryT lymphocytes. Thus sirolimus might achieve remission of Kaposi's sarcoma by restoring a specific immune response against the tumour-associated virus.