Extracorporeal Photopheresis Improves Survival in Hematopoietic Cell Transplant Patients with Bronchiolitis Obliterans Syndrome without Significantly Impacting Measured Pulmonary Functions

Mehrdad Hefazi, Kimberly J. Langer, Nandita D Khera, Jill Adamski, Vivek Roy, Jeffrey L. Winters, Dennis A. Gastineau, Eapen K. Jacob, Justin D. Kreuter, Manish J. Gandhi, William Hogan, Mark R Litzow, Shahrukh K. Hashmi, Hemang Yadav, Vivek N. Iyer, J. P. Scott, Mark Wylam, Rodrigo Cartin-Ceba, Mrinal M Patnaik

Research output: Contribution to journalArticle

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Abstract

We carried out the first matched retrospective cohort study aimed at studying the safety and efficacy of extracorporeal photopheresis (ECP) for bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (HCT). Medical records of 1325 consecutive adult patients who underwent HCT between 2005 and 2015 were reviewed. Seventy-four patients (median age, 51 years) with a diagnosis of BOS were included in the study. After propensity-score matching for BOS severity, 26 patients who underwent ≥3 months of ECP were matched to 26 non–ECP-treated patients, who were assigned an index date corresponding to the ECP start date for their matched pairs. The rate of decline in FEV1 percentage predicted (FEV1PP) decreased after ECP initiation (and after index date in the non-ECP group), with no significant difference between the 2 groups (P =.33). On a multivariable analysis that included baseline transplant and pulmonary function test variables, matched related donor HCT (HR,.1; 95% CI,.03 to.5; P =.002), ECP (HR,.1; 95% CI,.01 to.3; P =.001), and slower rate of decline in FEV1PP before the ECP/index date (HR,.7; 95% CI,.6 to.8; P =.001) were associated with a better overall survival. At last follow-up, non–ECP-treated patients were more likely to be on >5 mg daily dose of prednisone (54% versus 23%; P =.04) and had a greater decline in their Karnofsky performance score (mean difference, −9.5 versus −1.6; P =.06) compared with ECP-treated-patients. In conclusion, compared with other BOS-directed therapies, ECP was found to improve survival in HCT patients with BOS, without significantly impacting measured pulmonary functions. These findings need prospective validation in a larger patient cohort.

Original languageEnglish (US)
JournalBiology of Blood and Marrow Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

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Photopheresis
Bronchiolitis Obliterans
Transplants
Lung
Survival
Cell Transplantation
Propensity Score
Respiratory Function Tests
Prednisone
Medical Records
Cohort Studies
Retrospective Studies
Tissue Donors

Keywords

  • Bronchiolitis obliterans syndrome
  • Extracorporeal photopheresis
  • Graft-versus-host disease
  • Hematopoietic cell transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Extracorporeal Photopheresis Improves Survival in Hematopoietic Cell Transplant Patients with Bronchiolitis Obliterans Syndrome without Significantly Impacting Measured Pulmonary Functions. / Hefazi, Mehrdad; Langer, Kimberly J.; Khera, Nandita D; Adamski, Jill; Roy, Vivek; Winters, Jeffrey L.; Gastineau, Dennis A.; Jacob, Eapen K.; Kreuter, Justin D.; Gandhi, Manish J.; Hogan, William; Litzow, Mark R; Hashmi, Shahrukh K.; Yadav, Hemang; Iyer, Vivek N.; Scott, J. P.; Wylam, Mark; Cartin-Ceba, Rodrigo; Patnaik, Mrinal M.

In: Biology of Blood and Marrow Transplantation, 01.01.2018.

Research output: Contribution to journalArticle

Hefazi, Mehrdad ; Langer, Kimberly J. ; Khera, Nandita D ; Adamski, Jill ; Roy, Vivek ; Winters, Jeffrey L. ; Gastineau, Dennis A. ; Jacob, Eapen K. ; Kreuter, Justin D. ; Gandhi, Manish J. ; Hogan, William ; Litzow, Mark R ; Hashmi, Shahrukh K. ; Yadav, Hemang ; Iyer, Vivek N. ; Scott, J. P. ; Wylam, Mark ; Cartin-Ceba, Rodrigo ; Patnaik, Mrinal M. / Extracorporeal Photopheresis Improves Survival in Hematopoietic Cell Transplant Patients with Bronchiolitis Obliterans Syndrome without Significantly Impacting Measured Pulmonary Functions. In: Biology of Blood and Marrow Transplantation. 2018.
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abstract = "We carried out the first matched retrospective cohort study aimed at studying the safety and efficacy of extracorporeal photopheresis (ECP) for bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (HCT). Medical records of 1325 consecutive adult patients who underwent HCT between 2005 and 2015 were reviewed. Seventy-four patients (median age, 51 years) with a diagnosis of BOS were included in the study. After propensity-score matching for BOS severity, 26 patients who underwent ≥3 months of ECP were matched to 26 non–ECP-treated patients, who were assigned an index date corresponding to the ECP start date for their matched pairs. The rate of decline in FEV1 percentage predicted (FEV1PP) decreased after ECP initiation (and after index date in the non-ECP group), with no significant difference between the 2 groups (P =.33). On a multivariable analysis that included baseline transplant and pulmonary function test variables, matched related donor HCT (HR,.1; 95{\%} CI,.03 to.5; P =.002), ECP (HR,.1; 95{\%} CI,.01 to.3; P =.001), and slower rate of decline in FEV1PP before the ECP/index date (HR,.7; 95{\%} CI,.6 to.8; P =.001) were associated with a better overall survival. At last follow-up, non–ECP-treated patients were more likely to be on >5 mg daily dose of prednisone (54{\%} versus 23{\%}; P =.04) and had a greater decline in their Karnofsky performance score (mean difference, −9.5 versus −1.6; P =.06) compared with ECP-treated-patients. In conclusion, compared with other BOS-directed therapies, ECP was found to improve survival in HCT patients with BOS, without significantly impacting measured pulmonary functions. These findings need prospective validation in a larger patient cohort.",
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AU - Langer, Kimberly J.

AU - Khera, Nandita D

AU - Adamski, Jill

AU - Roy, Vivek

AU - Winters, Jeffrey L.

AU - Gastineau, Dennis A.

AU - Jacob, Eapen K.

AU - Kreuter, Justin D.

AU - Gandhi, Manish J.

AU - Hogan, William

AU - Litzow, Mark R

AU - Hashmi, Shahrukh K.

AU - Yadav, Hemang

AU - Iyer, Vivek N.

AU - Scott, J. P.

AU - Wylam, Mark

AU - Cartin-Ceba, Rodrigo

AU - Patnaik, Mrinal M

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N2 - We carried out the first matched retrospective cohort study aimed at studying the safety and efficacy of extracorporeal photopheresis (ECP) for bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (HCT). Medical records of 1325 consecutive adult patients who underwent HCT between 2005 and 2015 were reviewed. Seventy-four patients (median age, 51 years) with a diagnosis of BOS were included in the study. After propensity-score matching for BOS severity, 26 patients who underwent ≥3 months of ECP were matched to 26 non–ECP-treated patients, who were assigned an index date corresponding to the ECP start date for their matched pairs. The rate of decline in FEV1 percentage predicted (FEV1PP) decreased after ECP initiation (and after index date in the non-ECP group), with no significant difference between the 2 groups (P =.33). On a multivariable analysis that included baseline transplant and pulmonary function test variables, matched related donor HCT (HR,.1; 95% CI,.03 to.5; P =.002), ECP (HR,.1; 95% CI,.01 to.3; P =.001), and slower rate of decline in FEV1PP before the ECP/index date (HR,.7; 95% CI,.6 to.8; P =.001) were associated with a better overall survival. At last follow-up, non–ECP-treated patients were more likely to be on >5 mg daily dose of prednisone (54% versus 23%; P =.04) and had a greater decline in their Karnofsky performance score (mean difference, −9.5 versus −1.6; P =.06) compared with ECP-treated-patients. In conclusion, compared with other BOS-directed therapies, ECP was found to improve survival in HCT patients with BOS, without significantly impacting measured pulmonary functions. These findings need prospective validation in a larger patient cohort.

AB - We carried out the first matched retrospective cohort study aimed at studying the safety and efficacy of extracorporeal photopheresis (ECP) for bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (HCT). Medical records of 1325 consecutive adult patients who underwent HCT between 2005 and 2015 were reviewed. Seventy-four patients (median age, 51 years) with a diagnosis of BOS were included in the study. After propensity-score matching for BOS severity, 26 patients who underwent ≥3 months of ECP were matched to 26 non–ECP-treated patients, who were assigned an index date corresponding to the ECP start date for their matched pairs. The rate of decline in FEV1 percentage predicted (FEV1PP) decreased after ECP initiation (and after index date in the non-ECP group), with no significant difference between the 2 groups (P =.33). On a multivariable analysis that included baseline transplant and pulmonary function test variables, matched related donor HCT (HR,.1; 95% CI,.03 to.5; P =.002), ECP (HR,.1; 95% CI,.01 to.3; P =.001), and slower rate of decline in FEV1PP before the ECP/index date (HR,.7; 95% CI,.6 to.8; P =.001) were associated with a better overall survival. At last follow-up, non–ECP-treated patients were more likely to be on >5 mg daily dose of prednisone (54% versus 23%; P =.04) and had a greater decline in their Karnofsky performance score (mean difference, −9.5 versus −1.6; P =.06) compared with ECP-treated-patients. In conclusion, compared with other BOS-directed therapies, ECP was found to improve survival in HCT patients with BOS, without significantly impacting measured pulmonary functions. These findings need prospective validation in a larger patient cohort.

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