Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation

L. Bashoura; S. Gupta; A. Jain; D. R. Couriel; K. V. Komanduri; G. A. Eapen; A. Safdar; K. R. Broglio; R. Adachi; B. F. Dickey

doi:10.1038/sj.bmt.1705877

Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation

L. Bashoura, S. Gupta, A. Jain, D. R. Couriel, K. V. Komanduri, G. A. Eapen, A. Safdar, K. R. Broglio, R. Adachi, B. F. Dickey

Pulmonary Medicine

Research output: Contribution to journal › Article › peer-review

60 Scopus citations

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 1s (FEV1) declined from a median of 84% (range, 56-119) before HSCT to 53% (26-82) after HSCT. All patients received inhaled fluticasone propionate 500-940μg 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.

Original language	English (US)
Pages (from-to)	63-67
Number of pages	5
Journal	Bone marrow transplantation
Volume	41
Issue number	1
DOIs	https://doi.org/10.1038/sj.bmt.1705877
State	Published - Jan 2008

ASJC Scopus subject areas

Hematology
Transplantation

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title = "Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation",

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 1s (FEV1) declined from a median of 84% (range, 56-119) before HSCT to 53% (26-82) after HSCT. All patients received inhaled fluticasone propionate 500-940μg 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.",

author = "L. Bashoura and S. Gupta and A. Jain and Couriel, {D. R.} and Komanduri, {K. V.} and Eapen, {G. A.} and A. Safdar and Broglio, {K. R.} and R. Adachi and Dickey, {B. F.}",

note = "Funding Information: 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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AU - Bashoura, L.

AU - Gupta, S.

AU - Jain, A.

AU - Couriel, D. R.

AU - Komanduri, K. V.

AU - Eapen, G. A.

AU - Safdar, A.

AU - Broglio, K. R.

AU - Adachi, R.

AU - Dickey, B. F.

N1 - Funding Information: 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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N2 - 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 1s (FEV1) declined from a median of 84% (range, 56-119) before HSCT to 53% (26-82) after HSCT. All patients received inhaled fluticasone propionate 500-940μg 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.

AB - 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 1s (FEV1) declined from a median of 84% (range, 56-119) before HSCT to 53% (26-82) after HSCT. All patients received inhaled fluticasone propionate 500-940μg 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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Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation

Abstract

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