Question

The Case of the Cancerous Kiss. Part 3.

Six months after the transplant, Miley began experiencing fever, malaise, and fatigue. Her appetite decreased, and she was losing weight. At first she thought it was just a cold, but when these issues persisted for a little over a month, Miley decided she needed to go back to her doctor. Was something wrong with her new kidney? Her doctor ran some tests and discovered that she had post-transplantation lymphoproliferative disorder, a type of cancer.

The doctor explained that this was ultimately a result of her mono infection in college. Epstein-Barr virus, the cause of mono, is a herpes virus that causes a persistent infection in B cells, a type of immune cell. Normally, a person's healthy immune system cells prevent the growth of infected B cells as a way of limiting infection. But in Miley's case, the anti-rejection drugs that kept her transplanted kidney from being attacked by her body also suppressed her immune system's ability to attack the defective B cells. So, they reproduced unchecked, leading to cancer. This very serious condition occurs in 1 to 3 percent of adult kidney transplant patients and has a high fatality rate due to a lack of treatment options. Miley's doctor decided to immediately reduce her anti-rejection drugs in the hope that her own body would then be able to deal with the cancer, but it was a gamble, because the reduction in drugs could also cause her body to destroy her transplanted kidney. Miley was lucky. When the anti-rejection drugs were tapered, her immune system began destroying the cancerous B cells without rejecting the kidney.

Miley's treatment plan included reducing the dose of her immuno-suppressive drugs. Why did this help her overcome the cancer? (NCLEX style)

Decreasing the drug concentration would allow the immune system to be better at fighting off viruses, thereby decreasing the incidence of virally caused cancers.

It decreased inflammation, which is known to be linked to cancer.

It allowed her immune system to become more active and kill the cancer cells.

Decreasing the drugs would allow for greater growth of viruses. Some of these viruses would infect and kill the cancer cells.

Answer 1

The reason for Miley's recovery was due to reduction in the dose of her immuno-suppressive drugs.

Reason- It allowed her immune system to become more active and kill the cancer cells.

Miley's cancer was caused due to the defective B-cells becoming active. The defective B-cells were infected by a virus and were kept in control by the immune system. To prevent organ rejection after the kidney transplant, doctors had given her drugs which would reduce the activity of the immune system and thus reduce the chances of failure of the organ transplant. Suppressing the immune system had resulted in the increased activity of the infected B-cells. So, when the immuno-suppressive drugs were reduced, Miley's immune system became active and started to kill the infected B-cells.