TY - JOUR
T1 - Extracorporeal Photopheresis Improves Survival in Hematopoietic Cell Transplant Patients with Bronchiolitis Obliterans Syndrome without Significantly Impacting Measured Pulmonary Functions
AU - Hefazi, Mehrdad
AU - Langer, Kimberly J.
AU - Khera, Nandita
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 J.
AU - Litzow, Mark R.
AU - Hashmi, Shahrukh K.
AU - Yadav, Hemang
AU - Iyer, Vivek N.
AU - Scott, J. P.
AU - Wylam, Mark E.
AU - Cartin-Ceba, Rodrigo
AU - Patnaik, Mrinal M.
N1 - Funding Information:
The authors thank the staff at apheresis units and pulmonary labs at the Mayo Clinic in Rochester, MN, Scottsdale, AZ, and Jacksonville, FL, for their technical and logistical support. Financial disclosure: The authors have nothing to disclose. Conflict of interest statement: There are no conflicts of interest to report. Authorship statement: M.H. contributed to study conception, methodology, data collection, data analysis, and manuscript writing; K.J.L. contributed to data collection. N.K., J.A., V.R., J.L.W., D.A.G., E.K.J., M.R.L, and W.J.H. provided logistical and administrative support and contributed to patient care and manuscript writing. J.D.K., M.J.G., S.K.H., H.Y., and V.N.I. contributed to data interpretation and manuscript writing. J.P.S., M.E.W., and R.C.C, contributed to patient care, data interpretation, and manuscript writing. M.M.P. contributed to study conception, methodology, patients care, manuscript writing, and supervision. All authors contributed substantially to this work and have approved the submission of this manuscript.
Publisher Copyright:
© 2018 The American Society for Blood and Marrow Transplantation
PY - 2018/9
Y1 - 2018/9
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 FEV 1 percentage predicted (FEV 1PP ) 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 FEV 1PP 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 FEV 1 percentage predicted (FEV 1PP ) 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 FEV 1PP 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.
KW - Bronchiolitis obliterans syndrome
KW - Extracorporeal photopheresis
KW - Graft-versus-host disease
KW - Hematopoietic cell transplantation
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UR - http://www.scopus.com/inward/citedby.url?scp=85047178481&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2018.04.012
DO - 10.1016/j.bbmt.2018.04.012
M3 - Article
C2 - 29679771
AN - SCOPUS:85047178481
SN - 1083-8791
VL - 24
SP - 1906
EP - 1913
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 9
ER -