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Post-Transplant Events

Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 41, pages 63–67 (2008)Cite this article

Abstract

Post transplantation constrictive bronchiolitis (PTCB) is the most common pulmonary complication among long-term survivors of allogeneic hematopoietic stem cell transplantation (HSCT). It is a late manifestation of GVHD. Its treatment with high-dose systemic corticosteroids and other immunosuppressive regimens is associated with multiple side effects. Topical corticosteroids are used for the treatment of other manifestations of GVHD to minimize these side effects. We conducted a retrospective analysis of a series of adult patients to evaluate the efficacy of high-dose inhaled corticosteroids in the treatment of PTCB. Seventeen patients with new-onset airflow obstruction were diagnosed with PTCB. Their forced expiratory volume in 1 s (FEV1) declined from a median of 84% (range, 56–119) before HSCT to 53% (26–82) after HSCT. All patients received inhaled fluticasone propionate 500–940 μg two times daily. Symptoms of airway obstruction improved and FEV1 stabilized 3–6 months after treatment. We conclude that high-dose inhaled corticosteroids may be effective in the treatment of PTCB and propose a plausible mechanism of its action. A prospective evaluation of its efficacy is warranted.

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Acknowledgements

This work was supported by a Multidisciplinary Research Program grant, MD Anderson Cancer Center: Post-Transplantation Constrictive Bronchiolitis, and a grant from the National Institutes of Health (HL072984 to BFD).

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Authors and Affiliations

  1. Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    L Bashoura, S Gupta, A Jain, G A Eapen, R Adachi & B F Dickey

  2. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    D R Couriel & K V Komanduri

  3. Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    A Safdar

  4. Department of Biostatistics and Applied Mathematics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    K R Broglio

  5. Center for Lung Inflammation and Infection, Institute for Bioscience and Technology, Houston, TX, USA

    R Adachi & B F Dickey

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  1. L Bashoura
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  2. S Gupta
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  3. A Jain
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  9. R Adachi
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Correspondence to L Bashoura.

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Bashoura, L., Gupta, S., Jain, A. et al. Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation. Bone Marrow Transplant 41, 63–67 (2008). https://doi.org/10.1038/sj.bmt.1705877

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  • DOI: https://doi.org/10.1038/sj.bmt.1705877

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