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Extracorporeal photopheresis as a new supportive therapy for bronchiolitis obliterans syndrome after allogeneic stem cell transplantation

Bone Marrow Transplantation volume 51, pages 728–731 (2016)Cite this article

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Bronchiolitis obliterans syndrome (BOS) is one of most frequent late-onset non-infectious pulmonary complication after allogeneic hematopoietic stem cell transplantation. It occurs in ~14% of patients with cGvHD,1 usually within the first 2 years from transplant (but also several years later), and is characterised by high morbidity and mortality (5-year survival rate of 45 vs 75% in patients without BOS).2, 3 BOS is defined by the onset of progressive airflow obstruction in the absence of respiratory infection, usually correlated with the pathological pattern of obliterative bronchiolitis. At early stages, patients can be asymptomatic; later in the course of disease, respiratory infections or chest constriction due to advanced sclerotic GvHD or intrapulmonary processes may hinder the correct diagnosis.4, 5 Current treatment of BOS (macrolides, change or increase in immunosuppression-mainly steroids- and inhaled therapy6) still remains unsatisfactory with high mortality rates.7

Recently, extracorporeal photopheresis (ECP) has been reported as a promising option for treatment of BOS in two case series.8, 9 We report our preliminary experience on 13 chronic GvHD (cGvHD) patients with BOS refractory to standard treatment, treated with ECP in association to standard therapy.

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References

  1. Au BK, Au MA, Chien JW . Bronchiolitis obliterans syndrome epidemiology after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2011; 17: 1072–1078.

    Article  Google Scholar 

  2. Nakaseko C, Ozawa S, Sakaida E, Sakai M, Kanda Y, Oshima K et al. Incidence, risk factors and outcomes of bronchiolitis obliterans after allogeneic stem cell transplantation. Int J Hematol 2011; 93: 375–382.

    Article  Google Scholar 

  3. Ditschkowski M, Elmaagacli AH, Koldehoff M, Gromke T, Trenschel R, Beelen DW . Bronchiolitis obliterans after allogeneic hematopoietic SCT: further insight—new perspectives? Bone Marrow Transplant 2013; 48: 1224–1229.

    Article  CAS  Google Scholar 

  4. Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW et al. National institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 diagnosis and staging working group report. Biol Blood Marrow Transplant 2015; 21: 389–401.e1.

    Article  Google Scholar 

  5. Uhlving HH, Andersen CB, Christensen IJ, Gormsen M, Pedersen KD, Buchvald F et al. Biopsy-verified bronchiolitis obliterans and other noninfectious lung pathologies after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2014; 21: 531–538.

    Article  Google Scholar 

  6. Williams KM, Chien JW, Gladwin MT, Pavletic SZ . Bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation. JAMA 2009; 302: 306–314.

    Article  CAS  Google Scholar 

  7. Chien JW, Duncan S, Williams KM, Pavletic SZ . Bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation-an increasingly recognized manifestation of chronic graft-versus-host disease. Biol Blood Marrow Transplant 2010; 16: S106–S114.

    Article  Google Scholar 

  8. Lucid CE, Savani BN, Engelhardt BG, Shah P, Clifton C, Greenhut SL et al. Extracorporeal photopheresis in patients with refractory bronchiolitis obliterans developing after allo-SCT. Bone Marrow Transplant 2011; 46: 426–429.

    Article  CAS  Google Scholar 

  9. Brownback KR, Simpson SQ, Pitts LR, Polineni D, McGuirk JP, Ganguly S et al. Effect of extracorporeal photopheresis on lung function decline for severe bronchiolitis obliterans syndrome following allogeneic stem cell transplantation. J Clin Apher; e-pub ahead of print 29 May 2015; doi:10.1002/jca.21404.

  10. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945–956.

    Article  Google Scholar 

  11. Del Fante C, Scudeller L, Viarengo G, Bernasconi P, Perotti C . Response and survival of patients with chronic graft-versus-host disease treated by extracorporeal photochemotherapy: a retrospective study according to classical and National Institutes of Health classifications. Transfusion 2012; 52: 2007–2015.

    Article  Google Scholar 

  12. Del Fante C, Scudeller L, Oggionni T, Viarengo G, Cemmi F, Morosini M et al. Long-term off-line extracorporeal photochemotherapy in patients with chronic lung allograft rejection Not responsive to conventional treatment: a 10-year single-centre analysis. Respiration 2015; 90: 118–128.

    Article  CAS  Google Scholar 

  13. Philit F, Wiesendanger T, Archimbaud E, Mornex JF, Brune J, Cordier JF . Post-transplant obstructive lung disease (“bronchiolitis obliterans”): a clinical comparative study of bone marrow and lung transplant patients. Eur Respir J 1995; 8: 551–558.

    CAS  Google Scholar 

  14. Cooke KR, Ferrara JLM The pathophysiology of lung Injury after hematopoietic stem cell transplantation. In: James LM, Ferrra KRC, Deeg HJ (eds). Graft vs Host Disease, 3rd edn. Marcel Dekker: New York, NY, USA, 2005, pp 329–367.

    Google Scholar 

  15. Zhu L, Couriel DR, Chang CH . The effect of extracorporeal photopheresis on T cell response in chronic graft-versus-host disease. Leuk Lymphoma 2015, 1–9 (epub ahead of print).

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Authors and Affiliations

  1. Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy

    C Del Fante & C Perotti

  2. Department of Respiratory Diseases Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy

    T Galasso & F Meloni

  3. Department of Onco- Haematology, Bone marrow transplant unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy

    P Bernasconi & F Ripamonti

  4. Scientific Direction, Clinical Epidemiology and Biostatistics Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy

    L Scudeller

  5. Department of Molecular Medicine, University of Pavia, Pavia, Italy

    F Meloni

Authors
  1. C Del Fante
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  2. T Galasso
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  6. C Perotti
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  7. F Meloni
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Correspondence to C Del Fante.

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Del Fante, C., Galasso, T., Bernasconi, P. et al. Extracorporeal photopheresis as a new supportive therapy for bronchiolitis obliterans syndrome after allogeneic stem cell transplantation. Bone Marrow Transplant 51, 728–731 (2016). https://doi.org/10.1038/bmt.2015.324

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