1. ¹Service de Pneumologie, Hôpital Saint-Louis, Université Paris 7, UFR Denis Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France
2. ²Département de Biostatistiques, Hôpital Saint-Louis, Université Paris 7, UFR Denis Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France
3. ³Service de Greffe de moelle, Hôpital Saint-Louis, Université Paris 7, UFR Denis Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France

Correspondence: Dr A Tazi, Service de Pneumologie, Hôpital Saint-Louis, 1, avenue Claude Vellefaux, 75475, Paris cedex 10, France. E-mail: abdellatif.tazi@sls.aphp.fr

Received 30 August 2006; Revised 5 February 2007; Accepted 6 February 2007; Published online 12 March 2007.

Abstract

Bronchiolitis obliterans (BO) is a potentially life-threatening complication following allogeneic stem cell transplantation (SCT) and usually carries a poor prognosis. Immunosuppressive medications are the main treatment, but are rarely effective, especially when the disease is severe. Thus, both early detection and alternative therapeutic approaches of post SCT BO are needed. We report our experience with Budesonide/Formoterol, an inhaled steroid and long-acting bronchodilatator combination, in a group of patients with mild to moderately severe BO after SCT whose systemic immunosuppressive treatment had not been modified. Thirteen patients were treated. The diagnosis of BO was based on the presence of respiratory symptoms and air-trapping on expiratory lung high-resolution computed tomography in all patients, associated with irreversible airflow obstruction in seven cases. The median follow-up was 12.8 months (range: 5–29 months). All patients improved clinically, and both forced expiratory volume in 1 (FEV₁) and mean expiratory flow values increased significantly during follow-up (534268 ml in absolute values and 3627% compared to pretreatment values for FEV₁; P<0.02). These encouraging results provide new insights in the therapeutic approach of BO after SCT and require confirmation in a larger group of patients with a longer follow-up.