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

• Published in: Bone marrow transplantation (Basingstoke) Vol. 46; no. 3; pp. 426 - 429
• Main Authors: Lucid, C E, Savani, B N, Engelhardt, B G, Shah, P, Clifton, C, Greenhut, S L, Vaughan, L A, Kassim, A, Schuening, F, Jagasia, M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2011; Nature Publishing Group
• Subjects: 692/699/1785; 692/699/249/1529; 692/700/565/545/576/1955; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Apheresis; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Bronchiolitis; Bronchiolitis obliterans; Bronchiolitis Obliterans - complications; Bronchiolitis Obliterans - etiology; Bronchiolitis Obliterans - therapy; Bronchopneumonia; Care and treatment; Case reports; Cell Biology; Chronic obstructive pulmonary disease, asthma; Complications; Complications and side effects; Diagnosis; Female; Graft vs Host Disease - etiology; Graft vs Host Disease - therapy; Graft-versus-host reaction; Health aspects; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Immunosuppressive agents; Immunotherapy; Internal Medicine; Leukapheresis; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; original-article; Patients; Photodynamic therapy; Photopheresis - methods; Pneumology; Public Health; Pulmonary functions; Respiratory function; Risk factors; Stem cell transplantation; Stem Cells; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Young Adult; United States; bronchiolitis obliterans; GVHD; extracorporeal photopheresis; SCT; long-term survivors; Human; Immunopathology; Graft versus host disease; Treatment resistance; Hematology; Respiratory disease; Survivor; Stem cell; Hematopoietic cell; Homograft; Long term; Phototherapy; Treatment; Allogeneic hematopoietic stem cell transplantation; Graft; Bronchus disease; Bronchiolitis obliterans; Photopheresis
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2010.152

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.