Photopheresis in the Treatment of Refractory Bronchiolitis Obliterans Complicating Lung Transplantation

O’Hagan, Adrian; Stillwell, Paul C.; Arroliga, Alejandro C.; Koo, Anna P.

doi:10.1378/chest.115.5.1459

Cited by 85 publications

(48 citation statements)

References 7 publications

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“…86 Though several studies have been performed in patients with BO after HSCT [61][62][63][64][65][87][88][89][90][91] and lung transplantation, [92][93][94] the studies are difficult to interpret because of the heterogeneity in the treatment schedules, diagnostic criteria and response assessment criteria (Table 1). A prospective randomised study of extracorporeal photopheresis treatment performed by Flowers et al 61 revealed a significant improvement of cGVHD in the skin, and indicated a steroid sparing effect on cGvHD in general.…”

Section: Extracorporeal Photopheresismentioning

confidence: 99%

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

Uhlving

Buchvald

Heilmann

et al. 2011

Bone Marrow Transplant

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Bronchiolitis obliterans (BO) following allogeneic haematopoietic SCT (HSCT) is a serious complication affecting 1.7-26% of the patients, with a reported mortality rate of 21-100%. It is considered a manifestation of chronic graftversus-host disease, but our knowledge of aetiology and pathogenesis is still limited. Diagnostic criteria are being developed, and will allow more uniform and comparable research activities between centres. At present, no randomised controlled trials have been completed that could demonstrate an effective treatment. Steroids in combination with other immunosuppressive drugs still constitute the backbone of the treatment strategy, and results from our and other centres suggest that monthly infusions of high-dose pulse i.v. methylprednisolone (HDPM) might stabilise the disease and hinder progression. This article provides an overview of the current evidence regarding treatment options for BO and presents the treatment results with HDPM in a paediatric national HSCT-cohort.

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Section: Extracorporeal Photopheresismentioning

confidence: 99%

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

Uhlving

Buchvald

Heilmann

et al. 2011

Bone Marrow Transplant

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“…Further studies confirmed these data in a small number of patients (41,42) while the study by Villanueva et al (43) suggested a better effect of ECP in patients with early BOS. These data might be subjected to a lead time bias but still emphasize the importance of escalating therapy to prevent the progression of BOS/CLAD early.…”

Section: Extracorporeal Photopheresismentioning

confidence: 59%

Therapeutic options for bronchiolitis obliterans Syndrome after lung transplantation

Hangartner¹,

Schuurmans²,

Murer³

et al. 2016

Eurasian J Pulmonol

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The development of chronic lung allograft dysfunction (CLAD) is one of the major obstacles following lung transplantation and limits patients' long-term outcome. Within the group of emerging CLAD phenotypes, bronchiolitis obliterans syndrome is the most common form and observed in up to 75% of lung transplant recipients 10 years after transplantation. Therapeutic options to address BOS are limited and, at our center, include modification of immunosuppression, immunomodulation using macrolide antibiotics, the use of statins, leukotriene receptor antagonists, and extracorporeal photopheresis. The evidence for most of these therapy options is derived from case reports or small, descriptive studies, whereas controlled trials are yet to be conducted. In the context of an illustrative case report, we review hereby the current literature regarding these different treatment options.

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“…26 In addition, we and others have recently shown the efficacy of photopheresis in the reversal of both renal 27,28 and pulmonary allograft rejection. 29,30 Because hepatic allograft rejection is a pathophysiologically similar process, we postulated that photopheresis might be equally effective in its reversal. In this report, we present a patient with rejection refractory to all standard immunosuppressive therapy that was rapidly and durably reversed after ECP.…”

Section: Discussionmentioning

confidence: 99%

Successful Reversal of Recalcitrant Hepatic Allograft Rejection by Photopheresis

Lehrer

Ruchelli

Olthoff

et al. 2000

Liver Transplantation

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Extracorporeal photopheresis (ECP) is an immunologic modality that has shown efficacy in the treatment of clonal T-cell diseases, including Sézary syndrome and allograft rejection. In this case report, we expand on this observation to include recalcitrant hepatic allograft rejection. A 14-year-old boy with hepatic allograft rejection refractory to high-dose corticosteroid and lymphocytolytic therapy was treated with 4 sessions of ECP over a 6-week period. After 2 sessions, a liver biopsy showed complete reversal of acute cell-mediated rejection. No opportunistic infections or other adverse events were noted. Photopheresis appears to be a safe and effective modality for the treatment of refractory hepatic allograft rejection. (Liver Transpl 2000;6:644-647.)

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Photopheresis in the Treatment of Refractory Bronchiolitis Obliterans Complicating Lung Transplantation

Cited by 85 publications

References 7 publications

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

Therapeutic options for bronchiolitis obliterans Syndrome after lung transplantation

Successful Reversal of Recalcitrant Hepatic Allograft Rejection by Photopheresis

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