Initial Experience With Propranolol Treatment of Lymphatic Anomalies: A Case Series

Abstract

Lymphatic malformations (LMs) are congenital lymphatic lesions that impose significant and costly morbidities on affected patients. Treatment options are limited due to incomplete understanding of LM pathobiology. Expression of an activated β2-adrenergic receptor has been described in LM tissue, suggesting that this pathway may contribute to the clinical manifestations of LM. We hypothesized that propranolol, a β-adrenergic receptor antagonist, might improve symptoms of patients with LMs and lymphatic anomalies. A retrospective chart review of patients treated with propranolol as an adjunct therapy was conducted; analyses included demographic characteristics, clinical features, and response to propranolol. Three patients with cystic and noncystic LMs displayed clinical improvement at a minimum dose of 0.7 mg/kg/d, whereas symptomatic relapses were observed when propranolol doses dropped below this threshold. Two patients with Klippel-Trenaunay syndrome demonstrated partial clinical responses with reduced edema. The fetus of a mother treated with propranolol from a gestational age of 35 weeks through delivery displayed arrested growth of a cervicofacial LM. Our retrospective review suggests that propranolol improved symptoms in a subset of patients with lymphatic anomalies. Propranolol treatment may also limit the growth of congenital LMs in utero.

Treatment of Lymphatic Malformations with the mTOR Inhibitor Sirolimus: A Systematic Review

“…Pharmacologic treatment with different medications like sildenafil and propranolol has been examined to treat extensive lymphatic malformations without striking success. [31][32][33][34][35] Therefore, the potential utilization of sirolimus should be investigated.…”

Successful management of extremely high‐output refractory congenital chylothorax with chemical pleurodesis using 4% povidone–iodine and propranolol: a case report

“…While the literature on propranolol in lymphangiomas, still inconclusive; many reports have shown efficacy [26][27][28][29][30][31], which had been related to the expression of b2-ARs in the malformed lymphatic vessels [24]. Propranolol showed improvement of symptoms in a subset of patients with lymphatic anomalies and limited the growth of congenital LMs in utero.…”

“…Propranolol effects seemed to be dose‐dependent, with the lowest effective dose at 0.7 to 1 mg/kg/day. When propranolol was decreased or discontinued, qualitative experience and quantitative measures worsened .…”

Propranolol treatment for chylothorax due to diffuse lymphangiomatosis

“…Propranolol treatment is effective for the treatment of hemangiomas and lymphatic malformations . Nonetheless, its treatment mechanism has not been fully elucidated.…”