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[Lymphedema in patients treated with sirolimus: 15 cases]

C Fourgeaud1, L Simon1, B Benoughidane1

  • 1Unité de lymphologie, site constitutif du Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.

La Revue De Medecine Interne
|May 13, 2018
PubMed
Abstract

Insights

Sirolimus, an mTOR inhibitor, can cause limb lymphedema in transplant patients. Discontinuation of sirolimus did not improve lymphedema, suggesting unclear mechanisms and the need for compression management.

Area of Science:

  • Medical research
  • Pharmacology
  • Oncology

Background:

  • Sirolimus (mTOR inhibitor) is used in organ transplantation and for vascular malformations.
  • Limb lymphedema is a known adverse effect of sirolimus therapy.

Purpose of the Study:

  • To analyze clinical features of sirolimus-induced lymphedema.
  • To evaluate lymphoscintigraphy findings in affected patients.
  • To determine the outcome of lymphedema after sirolimus treatment.

Main Methods:

  • Retrospective monocentric study (2008-2017).
  • Inclusion of consecutive patients who developed lymphedema while on sirolimus.
  • Analysis of patient demographics, transplant history, sirolimus dosage, lymphedema characteristics, and lymphoscintigraphy results.

Main Results:

  • Fifteen patients (mean age 56) with transplants or lymphangioleiomyomatosis were included.
  • Lymphedema affected upper and/or lower limbs, with onset typically occurring within 52 weeks of sirolimus initiation.
  • Lymphoscintigraphy showed no nodal fixation or decreased uptake; discontinuation of sirolimus did not lead to improvement.

Conclusions:

  • Sirolimus is associated with upper and/or lower limb lymphedema, irrespective of sex.
  • Lymphedema often persists even after sirolimus discontinuation, indicating unclear pathophysiology.
  • Current management focuses on compression therapy.
Keywords:
Inhibiteur de mTORLymphedemaLymphœdèmeMTOR inhibitorSirolimus

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