Fluticasone, Azithromycin, and Montelukast Treatment for New-Onset Bronchiolitis Obliterans Syndrome after Hematopoietic Cell Transplantation

Kirsten M. Williams, Guang Shing Cheng, Iskra Pusic, Madan Jagasia, Linda Burns, Vincent T. Ho, Joseph Pidala, Jeanne Palmer, Laura Johnston, Sebastian Mayer, Jason W. Chien, David A. Jacobsohn, Steven Z. Pavletic, Paul J. Martin, Barry E. Storer, Yoshihiro Inamoto, Xiaoyu Chai, Mary E.D. Flowers, Stephanie J. Lee

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (HCT) is associated with high mortality. We hypothesized that inhaled fluticasone, azithromycin, and montelukast (FAM) with a brief steroid pulse could avert progression of new-onset BOS. We tested this in a phase II, single-arm, open-label, multicenter study (NCT01307462). Thirty-six patients were enrolled within 6 months of BOS diagnosis. The primary endpoint was treatment failure, defined as 10% or greater forced expiratory volume in 1 second decline at 3 months. At 3 months, 6% (2 of 36, 95% confidence interval, 1% to 19%) had treatment failure (versus 40% in historical controls, P <.001). FAM was well tolerated. Steroid dose was reduced by 50% or more at 3 months in 48% of patients who could be evaluated (n = 27). Patient-reported outcomes at 3 months were statistically significantly improved for Short-Form 36 social functioning score and mental component score, Functional Assessment of Cancer Therapies emotional well-being, and Lee symptom scores in lung, skin, mouth, and the overall summary score compared to enrollment (n = 24). At 6 months, 36% had treatment failure (95% confidence interval, 21% to 54%, n = 13 of 36, with 6 documented failures, 7 missing pulmonary function tests). Overall survival was 97% (95% confidence interval, 84% to 100%) at 6 months. These data suggest that FAM was well tolerated and that treatment with FAM and steroid pulse may halt pulmonary decline in new-onset BOS in the majority of patients and permit reductions in systemic steroid exposure, which collectively may improve quality of life. However, additional treatments are needed for progressive BOS despite FAM.

Original languageEnglish (US)
Pages (from-to)710-716
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume22
Issue number4
DOIs
StatePublished - Apr 1 2016

Fingerprint

montelukast
Bronchiolitis Obliterans
Azithromycin
Cell Transplantation
Treatment Failure
Steroids
Confidence Intervals
Therapeutics
Lung
Respiratory Function Tests
Forced Expiratory Volume
Multicenter Studies
Mouth
Quality of Life
Fluticasone
Skin

Keywords

  • Azithromycin
  • Bronchiolitis obliterans syndrome
  • Fluticasone
  • Hematopoietic cell transplantation
  • Leukotrienes
  • Lung chronic graft-versus-host disease
  • Montelukast

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Fluticasone, Azithromycin, and Montelukast Treatment for New-Onset Bronchiolitis Obliterans Syndrome after Hematopoietic Cell Transplantation. / Williams, Kirsten M.; Cheng, Guang Shing; Pusic, Iskra; Jagasia, Madan; Burns, Linda; Ho, Vincent T.; Pidala, Joseph; Palmer, Jeanne; Johnston, Laura; Mayer, Sebastian; Chien, Jason W.; Jacobsohn, David A.; Pavletic, Steven Z.; Martin, Paul J.; Storer, Barry E.; Inamoto, Yoshihiro; Chai, Xiaoyu; Flowers, Mary E.D.; Lee, Stephanie J.

In: Biology of Blood and Marrow Transplantation, Vol. 22, No. 4, 01.04.2016, p. 710-716.

Research output: Contribution to journalArticle

Williams, KM, Cheng, GS, Pusic, I, Jagasia, M, Burns, L, Ho, VT, Pidala, J, Palmer, J, Johnston, L, Mayer, S, Chien, JW, Jacobsohn, DA, Pavletic, SZ, Martin, PJ, Storer, BE, Inamoto, Y, Chai, X, Flowers, MED & Lee, SJ 2016, 'Fluticasone, Azithromycin, and Montelukast Treatment for New-Onset Bronchiolitis Obliterans Syndrome after Hematopoietic Cell Transplantation', Biology of Blood and Marrow Transplantation, vol. 22, no. 4, pp. 710-716. https://doi.org/10.1016/j.bbmt.2015.10.009
Williams, Kirsten M. ; Cheng, Guang Shing ; Pusic, Iskra ; Jagasia, Madan ; Burns, Linda ; Ho, Vincent T. ; Pidala, Joseph ; Palmer, Jeanne ; Johnston, Laura ; Mayer, Sebastian ; Chien, Jason W. ; Jacobsohn, David A. ; Pavletic, Steven Z. ; Martin, Paul J. ; Storer, Barry E. ; Inamoto, Yoshihiro ; Chai, Xiaoyu ; Flowers, Mary E.D. ; Lee, Stephanie J. / Fluticasone, Azithromycin, and Montelukast Treatment for New-Onset Bronchiolitis Obliterans Syndrome after Hematopoietic Cell Transplantation. In: Biology of Blood and Marrow Transplantation. 2016 ; Vol. 22, No. 4. pp. 710-716.
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