transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2021-13-3-272-279transplantologiya-587Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCASE REPORTSПолная регрессия генерализованной плазмоцитомы лимфатических узлов у реципиента трансплантата печени на фоне конверсии иммуносупрессивной терапии с такролимуса на эверолимусComplete regression of generalized plasmacytoma of lymph nodes in a liver transplant recipient during the conversion of immunosuppressive therapy from tacrolimus to everolimushttps://orcid.org/0000-0001-8391-5211СюткинВ. Е.SyutkinV. E.

Владимир Евгеньевич Сюткин, д-р мед. наук, ведущий научный сотрудник отделения трансплантации печени

129090, Россия, Москва, Большая Сухаревская пл., д. 3

Vladimir E. Syutkin, Dr. Sci. (Med.), Leading Research Associate, Department for Liver Transplantation

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0001-8428-1281ГородецкийВ. Р.GorodetskiyV. R.

Вадим Романович Городецкий, канд. мед. наук, ведущий научный сотрудник лаборатории интенсивных методов терапии

115522, Россия, Москва, Каширское ш., д. 34А

Vadim R. Gorodetskiy, Cand. Sci. (Med.), Leading Researcher, Laboratory of Intensive Therapy Methods

34A Kashirskoe Dr., Moscow 115522

https://orcid.org/0000-0002-2732-684XСалиенкоА. А.SalienkoA. A.

Анастасия Александровна Салиенко, врач-хирург операционного блока трансплантации печени

129090, Россия, Москва, Большая Сухаревская пл., д. 3

Anastasiya A. Salienko, Surgeon of the Operating Theatre for Liver Transplantation

3 Bolshaya Sukharevskaya Sq., Moscow 129090

salienkoaa@sklif.mos.ruhttps://orcid.org/0000-0002-3056-7062ПробатоваН. А.ProbatovaN. A.

Наталия Александровна Пробатова, д-р мед. наук, консультант отдела морфологической и молекулярно-генетической диагностики опухолей

115478, Россия, Москва, Каширское ш., д. 23

Nataliya A. Probatova, Dr. Sci. (Med.), Consultant of the Department for Morphological and Molecular-Genetic Diagnosis of Tumors

23 Kashirskoe Dr., Moscow 115478

https://orcid.org/0000-0001-8509-0954КупрышинаН. А.KupryshinaN. A.

Наталья Александровна Купрышкина, канд. мед. наук, старший научный сотрудник лаборатории иммунологии гемопоэза клинико-лабораторного отдела НИИ клинической онкологии им. Н.Н. Трапезникова

115478, Россия, Москва, Каширское ш., д. 23

Natalya A. Kupryshina, Cand. Sci. (Med.), Senior Researcher, Laboratory of Hematopoiesis Immunology at Clinical and Laboratory Departmen

23 Kashirskoe Dr., Moscow 115478

https://orcid.org/0000-0002-6362-7914НоврузбековМ. С.NovruzbekovM. S.

Мурад Сафтарович Новрузбеков, д-р мед. наук, заведующий научным отделением трансплантации печени

129090, Россия, Москва, Большая Сухаревская пл., д. 3

Murad S. Novruzbekov, Dr. Sci. (Med.), Head of the Scientific Department for Liver Transplantation

3 Bolshaya Sukharevskaya Sq., Moscow 129090

ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationФГБНУ «НИИ ревматологии им. В.А. Насоновой»РоссияResearch Institute of Rheumatology n.a. V.A. NasonovaRussian FederationФГБУ «НМИЦ онкологии им. Н.Н. Блохина» МЗ РФРоссияN.N. Blokhin National Medical Research Center of OncologyRussian Federation202121092021133272279Copyright © Сюткин В.Е., Городецкий В.Р., Салиенко А.А., Пробатова Н.А., Купрышина Н.А., Новрузбеков М.С., 20212021Сюткин В.Е., Городецкий В.Р., Салиенко А.А., Пробатова Н.А., Купрышина Н.А., Новрузбеков М.С.Syutkin V.E., Gorodetskiy V.R., Salienko A.A., Probatova N.A., Kupryshina N.A., Novruzbekov M.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/587

Введение. Одним из серьезных осложнений после трансплантации солидных органов и костного мозга является развитие посттрансплантационных лимфопролиферативных заболеваний.Клинический случай. Оценка течения посттрансплантационных лимфопролиферативных заболеваний в отдаленном периоде у реципиента печени после конверсии иммуносупрессивной терапии с такролимуса на эверолимус. Приводится анализ случая генерализованной первичной плазмоцитомы лимфатических узлов с вовлечением костного мозга у пациентки, перенесшей трансплантацию печени.Результаты. После конверсии иммуносупрессии наблюдалась быстрая положительная динамика в виде уменьшения размеров лимфатических узлов и снижения секреции парапротеина вплоть до полного его исчезновения. Нежелательных явлений, связанных с приемом эверолимуса на протяжении 4 лет, как и признаков недостаточности иммуносупрессии, не наблюдалось.Заключение. Данное наблюдение является первым описанием длительной ремиссии нодальной плазмоцитомы, развившейся у реципиента печени после полной отмены ингибиторов кальциневрина и назначения эверолимуса. Мы полагаем, что регресс посттрансплантационных лимфопролиферативных заболеваний на фоне замены ингибиторов кальциневрина на эверолимус связан не только с минимизацией экспозиции ингибиторов кальциневрина, но и с противоопухолевым действием самого эверолимуса, что позволяет обсуждать расширение возможностей его клинического применения.

Introduction. One of the serious complications after transplantation of solid organs and bone marrow is the development of post-transplant lymphoproliferative diseases.Clinical case. To evaluate the course of post-transplant lymphoproliferative diseases in the long-term in a liver transplant recipient after conversion of immunosuppressive therapy from tacrolimus to everolimus. We analyze a case of generalized primary plasmacytoma of lymph nodes with bone marrow involvement in a patient after liver transplantation.Results. After conversion of immunosuppression we observed a rapid positive trend: decreasing size of lymph nodes and regression of the level of paraprotein down to its complete disappearance. There were neither adverse events associated with everolimus for four years, nor signs of immunosuppression insufficiency.Conclusion. This Case Report is the first description of a long-term remission of nodal plasmacytoma that developed in a liver transplant recipient after complete withdrawal of calcineurin inhibitors and administration of everolimus. We suggest that the regression of post-transplant lymphoproliferative diseases after replacing calcineurin inhibitors with everolimus is associated not only with the minimization of calcineurin inhibitors exposure, but also with the antitumor effect of the everolimus itself, which prompts us to discuss the possibilities of expanding its clinical application.

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The authors declare that there are no conflicts of interest present.