Brief CommunicationCyclophosphamide rescue therapy for chronic rejection after lung transplantation
Section snippets
Patients and methods
In an open, uncontrolled study, we have analyzed the effect of rescue treatment with cyclophosphamide in 7 patients with chronic rejection, not responding to conventional therapy with high doses of intravenous steroids, antilymphocyte products, or both. They had all been treated with rATG induction therapy and triple immunosuppression, consisting of cyclosporine, azathioprine, and steroids. In one patient cyclosporine has been switched to FK506 because of recurrent acute rejection episodes. The
Results
For the whole patient group, the best FEV1 after transplantation, was 2.19 ± 0.75 L (range, 0.94 to 2.9 L). Three months before starting cyclophosphamide, the FEV1 had significantly declined to 1.90 ± 0.83 L (range, 0.83 to 2.56 L; p = 0.03). At the time of initiating cyclophosphamide, the FEV1 had further declined to 1.63 ± 0.64 L (range, 0.54 to 2.4 L; p = 0.0003 vs the best post-operative FEV1). This represents a mean decline in FEV1 of 0.13 ± 0.11 L per month over the last 3 months. The
Discussion
Since it has been demonstrated that augmentation of the immunosuppressive therapy can stop the progression of OB/BOS in a number of patients,7 many therapeutic regimens have been used to tackle this problem. Amongst them, changing of cyclosporine to FK506 or azathioprine to MMF were quite successful. The role of cyclophosphamide in the treatment of chronic rejection after (H)LTx remains unknown. After an initial success with this therapy in one patient,8 we have now presented the results in 7
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Cited by (39)
Therapy options for chronic lung allograft dysfunction–bronchiolitis obliterans syndrome following first-line immunosuppressive strategies: A systematic review
2017, Journal of Heart and Lung TransplantationCitation Excerpt :The studies observed a reduction in the rate of FEV1 decline after initiating therapy across treatments, but the uncontrolled design of the studies limited comparison (Table 2). The most commonly reported adverse events were unspecified respiratory infections (alemtuzumab)12 and leucopenia (cyclophosphamide, methotrexate; Table 2).16,31 Two uncontrolled studies of mesenchymal stem cells therapy were only available as 2016 congress abstracts pending full publication.29,30
Effectiveness of Rabbit Antithymocyte Globulin in Chronic Lung Allograft Dysfunction
2016, Transplantation ProceedingsPediatric Lung Transplantation
2010, Pediatric Clinics of North AmericaCitation Excerpt :Similar findings were noted with the switch from azathioprine to mycophenolate mofetil. Other medications that have been attempted include pulse steroids, methotrexate,57 cyclophosphamide,58 cytolytic therapy,59 inhaled cyclosporine,60 total lymphoid irradiation,61 and photophoresis.62,63 However, despite this extensive list of potential strategies, treatment success has been fairly limited and improvement of lung function is uncommon, probably because the fibroproliferative process is not reversible.
Bronchiolitis Obliterans Syndrome: Alloimmune-Dependent and -Independent Injury with Aberrant Tissue Remodeling
2008, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :However, their ability to reduce the development of BOS remains to be clarified. Other treatments that have been reported to arrest or reverse some loss of pulmonary function include methotrexate,63 cyclophosphamide,64 photopheresis,65 and total lymphoid irradiation.66 Since these are small retrospective studies, further investigation is clearly required.
American Society of Transplantation executive summary on pediatric lung transplantation
2007, American Journal of TransplantationAllograft rejection after lung transplantation
2005, Clinics in Chest Medicine