Azithromycin for the Treatment of Obliterative Bronchiolitis after Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis

Abstract

Obliterative bronchiolitis (OB) is a major cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). Our objective was to perform a systematic review and meta-analysis of the impact of azithromycin on change in forced expiratory volume in 1 second (FEV1). We searched MEDLINE, EMBASE, Web of Science, Cochrane CENTRAL and Scopus databases. We included studies that compared azithromycin to placebo or no intervention in the treatment of OB or BOS in patients who had undergone allogeneic HSCT. 91 unique publications were identified. 4 studies met inclusion criteria, with a total of 90 patients. Changes in FEV1 were measured between 12 weeks and 24 weeks after initiation of treatment. The meta-analysis demonstrated a mean increase in FEV1 of 30 ml (95% Confidence Interval: -260 to +330 ml, p = 0.82) following initiation of azithromycin. One patient death was reported, but not attributed to azithromycin therapy. In conclusion, current evidence can neither support nor refute the use of azithromycin in the treatment of patients who develop OB/BOS following HSCT. Further studies are needed to determine whether azithromycin is beneficial for the treatment of OB/BOS in this setting.

Efficacy of high‐dose steroids for bronchiolitis obliterans syndrome post pediatric hematopoietic stem cell transplantation

“…In spite of the small number of patients in this cohort, given that there is very limited literature about BOS post‐pediatric HSCT with limited evidence‐based treatment options, the present results warrant further study of this treatment modality to control BOS. Our results compare favorably with the reported outcomes of currently suggested alternative treatments for BOS, including inhaled corticosteroids, azithromycin, the combination of fluticasone, azithromycin, and montelukast, and extra‐corporal photopheresis …”

Postinfectious Bronchiolitis Obliterans in Children: Diagnostic Workup and Therapeutic Options: A Workshop Report

“…Apart from reports with significant clinical response to azithromycin, there are studies where azithromycin therapy did not show any improvement in lung function. A systemic review and meta-analysis on the impact of azithromycin on change in FEV 1 shows that there was no sufficient evidence to support or refute the use of azithromycin in the treatment of patients who develop BOS post-HSCT [74].…”

Bronchiolitis obliterans syndrome ‘endotypes’ in haematopoietic stem cell transplantation

“…Analogous endotypes amongst haematopoietic stem cell transplant recipients are less well described, and perhaps as a consequence, management remains largely empirical. For example, there is currently no convincing evidence for the efficacy of azithromycin in the haematopoietic stem cell transplant BOS group, but the studies that have been carried out have not attempted to enrich for subgroups of patients potentially more likely to respond.…”