Fluticasone, azithromycin and montelukast therapy in reducing corticosteroid exposure in bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: a case series of eight patients
Fluticasone, azithromycin and montelukast therapy in reducing corticosteroid exposure in bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: a case series of eight patients
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DOI：
10.1038/bmt.2010.311
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发表时间：
2011-10-01
影响因子：
4.8
通讯作者：
Chien, J. W.
中科院分区：
文献类型：
--
作者：
Norman, B. C.;Jacobsohn, D. A.;Chien, J. W.
闭塞性细支气管炎综合征 (BOS) 是一种毁灭性的肺部并发症，影响异基因造血细胞移植的长期幸存者。长期使用大剂量皮质类固醇治疗 BOS 通常会导致严重的发病率。减少皮质类固醇的暴露可能会降低治疗相关的发病率。我们的机构最近开始用新兴疗法治疗患者，以减少皮质类固醇的暴露。我们回顾性审查了 8 名新诊断 BOS 患者的 6 个月皮质类固醇暴露、肺功能和失败率，这些患者接受氟替卡松、阿奇霉素和孟鲁司特 (FAM) 联合治疗并快速逐渐减量皮质类固醇。这些患者与 14 名匹配的既往患者进行了比较，这些患者接受了高剂量皮质类固醇治疗，随后进行了标准减量治疗。 FAM 治疗患者的中位 6 个月泼尼松暴露量为 1819 mg（0-4036 mg），而对照组为 7163 mg（6551-7829 mg）（P = 0.002）。 FAM 治疗患者的 1 秒用力呼气量中位数 (FEV(1)) 变化为 2%（-3 至 4%），而对照组为 1%（-4 至 5%）（P = 1.0）。FAM 患者的泼尼松暴露量是回顾性匹配组患者的四分之一，中位 FEV(1) 变化最小，表明 BOS 可能免受与使用副作用较小的替代药物长期使用皮质类固醇 (Bone Marrow Transplantation) (2011) 46, 1369-1373；doi: 10.1038/bmt.2010.311，2010 年 12 月 6 日在线发布；
Bronchiolitis obliterans syndrome (BOS) is a devastating pulmonary complication affecting long-term survivors of allogeneic hematopoietic cell transplantation. Treatment of BOS with prolonged courses of high dose corticosteroids is often associated with significant morbidity. Reducing the exposure to corticosteroids may reduce treatment-related morbidity. Our institution has recently begun to treat patients with emerging therapies in an effort to diminish corticosteroid exposure. We retrospectively reviewed the 6-month corticosteroid exposure, lung function and failure rates in eight patients with newly diagnosed BOS who were treated with a combination of fluticasone, azithromycin and montelukast (FAM) and a rapid corticosteroid taper. These patients were compared with 14 matched historical patients who received high-dose corticosteroids, followed by a standard taper. The median 6-month prednisone exposure in FAM-treated patients was 1819 mg (0-4036 mg) compared with 7163 mg (6551-7829 mg) in the control group (P = 0.002). The median forced expiratory volume in 1s (FEV(1)) change in FAM-treated patients was 2% (-3 to 4%] compared with 1% (-4 to 5%) in the control group (P = 1.0). Prednisone exposure in FAM patients was one quarter that of a retrospective-matched group of patients, with minimal change in median FEV(1), suggesting that BOS may be spared of the morbidities associated with long-term corticosteroid use by using alternative agents with less side effects. Bone Marrow Transplantation (2011) 46, 1369-1373; doi: 10.1038/bmt.2010.311; published online 6 December 2010