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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Sirolimus in Infants with Multiple Cardiac Rhabdomyomas Associated with Tuberous Sclerosis Complex
Maurizio Lucchesi1, Enrico Chiappa2, Flavio Giordano3
1Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's University Hospital, Florence, Italy.
Insights
Sirolimus effectively reduced cardiac rhabdomyomas in infants with tuberous sclerosis. This mTOR inhibitor showed significant tumor reduction, offering a promising treatment for this rare condition.
Area of Science:
- Cardiology
- Oncology
- Genetics
Background:
- Cardiac rhabdomyomas are a common feature of tuberous sclerosis.
- Tumor growth can lead to severe outcomes, including fetal or neonatal death in 10% of cases.
Observation:
- Three infants under 12 months with cardiac rhabdomyomas were treated with sirolimus.
- Sirolimus is an oral mTOR inhibitor used in this study.
Findings:
- All patients experienced significant cardiac rhabdomyoma reduction.
- Two patients achieved complete response, one had >50% debulking.
- Median time to best response was 1.9 months; side effects were acceptable.
Implications:
- Sirolimus may promote natural regression of cardiac rhabdomyomas.
- Further prospective clinical trials are warranted to confirm efficacy and safety.
Introduction:
Cardiac rhabdomyomas represent a frequent manifestation of tuberous sclerosis. Tumor growth, mainly prenatally, can result in intrauterine fetal or neonatal deaths in almost 10% of patients.
Case Report:
We treated 3 consecutive infants aged less than 12 months with sirolimus, an oral mTOR inhibitor. All patients achieved significant reductions in cardiac rhabdomyomas. A complete response was documented in 2 patients, while a partial response with tumor debulking greater than 50% was seen in the other one. The median time to best cardiac response was 1.9 months in all patients, and 3.3 months in those with complete response. The side effects profile was acceptable.
Conclusion:
Sirolimus may have a significant role in promoting natural regression of cardiac rhabdomyomas. Prospective clinical trials are needed.
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