Aerosol granulocyte-macrophage colony-stimulating factor for pulmonary alveolar proteinosis

Mark Wylam, R. Ten, U. B.S. Prakash, H. F. Nadrous, M. L. Clawson, P. M. Anderson

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Recently, granulocyte-macrophage colony-stimulating factor (GM-CSF) auto-antibodies have been found in many patients with pulmonary alveolar proteinosis (PAP). The present study reports a retrospective case series of patients who used aerosolised GM-CSF in the treatment of idiopathic PAP. Between 1999 and 2003, 12 patients elected to receive aerosolised GM-CSF (250 μg b.i.d. every other week) in lieu of whole-lung lavage or observation. Patient characteristics, pulmonary function tests, arterial blood gas analysis, laboratory values and chest radiographs were extracted from the patient's medical records. Of the six patients tested, all had GM-CSF neutralising antibodies. Additionally, abnormalities in GM-CSF gene expression (one patient), receptor expression (two patients) and ability to upregulate adhesion molecules (one patient) were found. All patients except one had a positive response (mean improvements in arterial oxygen tension, alveolar-arterial oxygen gradient, carbon monoxide diffusing capacity of the lung and forced vital capacity were 17.1 mmHg, 18.4 mmHg, 16.6% pred and 13.5% pred, respectively). Two patients made a complete recovery and were disease free 1 and 2 yrs after discontinuing treatment. Four patients showed complete response to both the initial course or when treated again for recurrence after discontinuation of treatment. One patient required dose escalation (500 μg b.i.d.) with complete response. GM-CSF was well tolerated without late toxicity after median (range) follow-up of 30.5 (3-68) months. In conclusion, aerosolised granulocyte-macrophage colony-stimulating factor is safe and effective in treating pulmonary alveolar proteinosis providing an alternative to whole-lung lavage or subcutaneous granulocyte-macrophage colony-stimulating factor.

Original languageEnglish (US)
Pages (from-to)585-593
Number of pages9
JournalEuropean Respiratory Journal
Volume27
Issue number3
DOIs
StatePublished - Mar 1 2006

Fingerprint

Pulmonary Alveolar Proteinosis
Granulocyte-Macrophage Colony-Stimulating Factor
Aerosols
Bronchoalveolar Lavage
Oxygen
Lung Volume Measurements
Blood Gas Analysis
Respiratory Function Tests
Vital Capacity
Carbon Monoxide
Neutralizing Antibodies

Keywords

  • Granulocyte-macrophage colony-stimulating factor
  • Pulmonary alveolar proteinosis surfactant

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Aerosol granulocyte-macrophage colony-stimulating factor for pulmonary alveolar proteinosis. / Wylam, Mark; Ten, R.; Prakash, U. B.S.; Nadrous, H. F.; Clawson, M. L.; Anderson, P. M.

In: European Respiratory Journal, Vol. 27, No. 3, 01.03.2006, p. 585-593.

Research output: Contribution to journalArticle

Wylam, Mark ; Ten, R. ; Prakash, U. B.S. ; Nadrous, H. F. ; Clawson, M. L. ; Anderson, P. M. / Aerosol granulocyte-macrophage colony-stimulating factor for pulmonary alveolar proteinosis. In: European Respiratory Journal. 2006 ; Vol. 27, No. 3. pp. 585-593.
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