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Post-Transplant Events

Extracorporeal photopheresis in patients with refractory bronchiolitis obliterans developing after allo-SCT

Bone Marrow Transplantation volume 46, pages 426–429 (2011)Cite this article

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Abstract

Extracorporeal photopheresis (ECP) has been shown to be a promising treatment for chronic graft-versus-host disease; however, only a few case reports are available that examine the effectiveness of ECP for bronchiolitis obliterans (BO) after allo-SCT. Because of the poor response to traditional therapies, ECP has been explored as a possible therapeutic option for severe BO after allo-SCT. Nine patients received ECP between July 2008 and August 2009 after a median follow-up of 23 months (range 9–93 months) post transplant. The primary indication for ECP was the development of BO in patients who had failed prior multidrug regimens. The median number of drugs used for BO management before ECP was 5 (range 2–7); this included immunosuppressive therapy. Six of nine (67%) patients responded to ECP after a median of 25 days (range 20–958 days). No ECP-related complications occurred. ECP seemed to stabilize rapidly declining pulmonary function tests in about two-thirds of patients with severe and heavily pretreated BO that developed after allo-SCT. This finding supports the need for a larger prospective study to confirm the impact of ECP on BO, and to consider earlier intervention with ECP to improve the outcome of BO after allo-SCT.

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References

  1. Socie G, Stone JV, Wingard JR, Weisdorf D, Henslee-Downey PJ, Bredeson C et al. Long-term survival and late deaths after allogeneic bone marrow transplantation. Late Effects Working Committee of the International Bone Marrow Transplant Registry. N Engl J Med 1999; 341: 14–21.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Savani BN, Montero A, Wu C, Nlonda N, Read E, Dunbar C et al. Prediction and prevention of transplant-related mortality from pulmonary causes after total body irradiation and allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2005; 11: 223–230.

    Article  PubMed  Google Scholar 

  5. Savani BN, Montero A, Srinivasan R, Singh A, Shenoy A, Mielke S et al. Chronic GVHD and pretransplantation abnormalities in pulmonary function are the main determinants predicting worsening pulmonary function in long-term survivors after stem cell transplantation. Biol Blood Marrow Transplant 2006; 12: 1261–1269.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bacigalupo A, Lamparelli T, Barisione G, Bruzzi P, Guidi S, Alessandrino PE et al. Thymoglobulin prevents chronic graft-versus-host disease, chronic lung dysfunction, and late transplant-related mortality: long-term follow-up of a randomized trial in patients undergoing unrelated donor transplantation. Biol Blood Marrow Transplant 2006; 12: 560–565.

    Article  PubMed  Google Scholar 

  7. Jagasia MH, Savani BN, Stricklin G, Engelhardt B, Kassim A, Dixon S et al. Classic and overlap chronic graft-versus-host disease (cGVHD) is associated with superior outcome after extracorporeal photopheresis (ECP). Biol Blood Marrow Transplant 2009; 15: 1288–1295.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Couriel D, Hosing C, Saliba R, Shpall EJ, Andelini P, Popat U et al. Extracorporeal photopheresis for acute and chronic graft-versus-host disease: does it work? Biol Blood Marrow Transplant 2006; 12 (1 Suppl 2): 37–40.

    Article  PubMed  Google Scholar 

  9. Morrell MR, Despotis GJ, Lublin DM, Patterson GA, Trulock EP, Hachem RR . The efficacy of photopheresis for bronchiolitis obliterans syndrome after lung transplantation. J Heart Lung Transplant 2010; 29: 424–431.

    Article  PubMed  Google Scholar 

  10. Chien JW, Martin PJ, Gooley TA, Flowers ME, Heckbert SR, Nichols WG et al. Airflow obstruction after myeloablative allogeneic hematopoietic stem cell transplantation. Am J Respir Crit Care Med 2003; 168: 208–214.

    Article  PubMed  Google Scholar 

  11. Khalid M, Al Saghir A, Saleemi S, Al Dammas S, Zeitouni M, Al Mobeireek A et al. Azithromycin in bronchiolitis obliterans complicating bone marrow transplantation: a preliminary study. Eur Respir J 2005; 25: 490–493.

    Article  CAS  PubMed  Google Scholar 

  12. Jain R, Hachem RR, Morrell MR, Trulock EP, Chakinala MM, Yusen RD et al. Azithromycin is associated with increased survival in lung transplant recipients with bronchiolitis obliterans syndrome. J Heart Lung Transplant 2010; 29: 531–537.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bashoura L, Gupta S, Jain A, Couriel DR, Komanduri KV, Eapen GA et al. Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation. Bone Marrow Transplant 2008; 41: 63–67.

    Article  CAS  PubMed  Google Scholar 

  14. Fullmer JJ, Fan LL, Dishop MK, Rodgers C, Krance R . Successful treatment of bronchiolitis obliterans in a bone marrow transplant patient with tumor necrosis factor-alpha blockade. Pediatrics 2005; 116: 767–770.

    Article  PubMed  Google Scholar 

  15. Majhail NS, Schiffer CA, Weisdorf DJ . Improvement of pulmonary function with imatinib mesylate in bronchiolitis obliterans following allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2006; 12: 789–791.

    Article  PubMed  Google Scholar 

  16. Or R, Gesundheit B, Resnick I, Bitan M, Avraham A, Avgil M et al. Sparing effect by montelukast treatment for chronic graft versus host disease: a pilot study. Transplantation 2007; 83: 577–581.

    Article  PubMed  Google Scholar 

  17. Johnson BA, Iacono AT, Zeevi A, McCurry KR, Duncan SR . Statin use is associated with improved function and survival of lung allografts. Am J Respir Crit Care Med 2003; 167: 1271–1278.

    Article  PubMed  Google Scholar 

  18. Harrison DE, Strong R, Sharp ZD, Nelson JF, Astle CM, Flurkey K et al. Rapamycin fed late in life extends lifespan in genetically heterogeneous mice. Nature 2009; 460: 392–395.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Alder JK, Chen JJ, Lancaster L, Danoff S, Su SC, Cogan JD et al. Short telomeres are a risk factor for idiopathic pulmonary fibrosis. Proc Natl Acad Sci USA 2008; 105: 13051–13056.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Savale L, Chaouat A, Bastuji-Garin S, Marcos E, Boyer L, Maitre B et al. Shortened telomeres in circulating leukocytes of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009; 179: 566–571.

    Article  CAS  PubMed  Google Scholar 

  21. Tsakiri KD, Cronkhite JT, Kuan PJ, Xing C, Raghu G, Weissler JC et al. Adult-onset pulmonary fibrosis caused by mutations in telomerase. Proc Natl Acad Sci USA 2007; 104: 7552–7557.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Armand P, Kim HT, Cutler CS, Ho VT, Koreth J, Ritz J et al. A prognostic score for patients with acute leukemia or myelodysplastic syndromes undergoing allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2008; 14: 28–35.

    Article  CAS  PubMed  Google Scholar 

  23. Iacono AT, Corcoran TE, Griffith BP, Grgurich WF, Smith DA, Zeevi A et al. Aerosol cyclosporin therapy in lung transplant recipients with bronchiolitis obliterans. Eur Respir J 2004; 23: 384–390.

    Article  CAS  PubMed  Google Scholar 

  24. Iacono AT, Johnson BA, Grgurich WF, Youssef JG, Corcoran TE, Seiler DA et al. A randomized trial of inhaled cyclosporine in lung-transplant recipients. N Engl J Med 2006; 354: 141–150.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Medicine, Long-Term Follow-up Transplant Clinic, Hematology and Stem Cell Transplantation Section, Vanderbilt University Medical Center, Nashville, TN, USA

    C E Lucid, B N Savani, B G Engelhardt, C Clifton, L A Vaughan, A Kassim, F Schuening & M Jagasia

  2. Division of Allergy and Pulmonary Medicine, Department of Medicine, Lung Transplantation Program, Vanderbilt University Medical Center, Nashville, TN, USA

    P Shah

  3. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    S L Greenhut

Authors
  1. C E Lucid
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  2. B N Savani
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  3. B G Engelhardt
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  4. P Shah
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  5. C Clifton
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  6. S L Greenhut
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  7. L A Vaughan
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  8. A Kassim
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  9. F Schuening
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  10. M Jagasia
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Correspondence to B N Savani.

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Lucid, C., Savani, B., Engelhardt, B. et al. Extracorporeal photopheresis in patients with refractory bronchiolitis obliterans developing after allo-SCT. Bone Marrow Transplant 46, 426–429 (2011). https://doi.org/10.1038/bmt.2010.152

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