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Ruxolitinib is an effective steroid sparing agent in bronchiolitis obliterans due to chronic graft-versus-host-disease

Bone Marrow Transplantation volume 55, pages 1194–1196 (2020)Cite this article

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Bronchiolitis obliterans syndrome (BOS) is the most common pulmonary manifestation of chronic graft-versus-host-disease (cGVHD) [1] and carries significant morbidity and mortality. Therapy has consisted of systemic steroids and a combination of inhaled corticosteroids, azithromycin, and montelukast referred to as Fluticasone, Azithromycin, and Montelukast (FAM) therapy [2]. Systemic steroids are considered the backbone of therapy. However, steroids have numerous side effects such as hyperglycemia, weight gain, and need for Pneumocystis jiroveci pneumonia (PJP) prophylaxis at high doses. In addition, the ALLOZITHRO [3] trial showed that azithromycin was not only ineffective but is also associated with a relapse of leukemia when used as part of FAM therapy. Thus, it is imperative for safe and effective therapies to be found.

Ruxolitinib is a JAK 1/2 inhibitor that is approved for treatment of polycythemia vera and myelofibrosis. Its mechanism of action involves promoting production of regulatory T cells and impairing differentiation of CD4+ T cells into interferon-gamma and IL-17A-producing cells to reduce proinflammatory signaling [4]. Though ruxolitinib has shown excellent response rates in steroid-refractory/intolerant cGVHD [5], there have been no published studies in adults regarding the efficacy of ruxolitinib for the indication of steroid-refractory/intolerant BOS. Ruxolitinib has been evaluated for this indication in pediatric patients and the results published in this journal in 1/2019 [6], but not adults yet.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas, 3901 Rainbow Blvd. MS 3007, Kansas City, KS, USA

    Christopher Streiler, Faizan Shaikh & Kyle R. Brownback

  2. University of Kansas School of Medicine, Kansas City, KS, USA

    Christian Davis

  3. Department of Hematologic Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS, USA

    Sunil Abhyankar

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  1. Christopher Streiler
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Correspondence to Christopher Streiler.

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Streiler, C., Shaikh, F., Davis, C. et al. Ruxolitinib is an effective steroid sparing agent in bronchiolitis obliterans due to chronic graft-versus-host-disease. Bone Marrow Transplant 55, 1194–1196 (2020). https://doi.org/10.1038/s41409-019-0662-6

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