Cyclophosphamide in severe steroid-resistant bronchiolitis obliterans organizing pneumonia

Abstract

A patient receiving carbamazepine and imipramine presented with severe bronchiolitis obliterans organizing pneumonia (BOOP). He developed progressive respiratory failure in spite of high-dose steroid treatment. Cyclophosphamide was given as adjunctive therapy, and a rapid improvement was seen. The authors suggest that an early therapeutic trial of cyclophosphamide should be considered in patients with BOOP who fail to respond to steroids.

Adjunctive Effects of Cyclosporine and Macrolide in Rapidly Progressive Cryptogenic Organizing Pneumonia with no Prompt Response to Steroid

“…Minimal data have been reported regarding alternative immunosuppressive agents in cases of corticosteroid refractory OP (9)(10)(11)(12)(13). Some reports suggest that early treatment with cyclophosphamide can be effective, especially in patients that fail to respond to treatment with corticosteroids alone (9,11).…”

“…However, some patients exhibit rapidly progressive disease that is often refractory to steroids and is associated with a poor outcome (1,(5)(6)(7)(8). To date, anecdotes of successful cases in which non-steroidal agents have been used to treat patients with steroid-resistant OP have been rarely reported (9,10). Thus, little information is currently available to aid in treating this condition.…”

Cryptogenic organising pneumonia

“…Although hypoxaemia with alveolar right-to-left shunt may be well tolerated as mentioned previously, other patients may require mechanical ventilation (noninvasive or with tracheal intubation) or progress to death, especially when corticosteroid treatment is delayed [400,401]. This occurs particularly in patients with delayed diagnosis who may improve once corticosteroid treatment is given (sometimes in association with immunosuppressive agents when corticosteroid resistance is suspected) [248,[402][403][404][405][406][407]. In some patients, underlying conditions or exposure (connective tissue disease, drugs, infection) are associated [248,408].…”

Successful treatment of three patients with organizing pneumonia associated with rheumatoid arthritis using clarithromycin and prednisolone

“…Minimal data have been reported regarding alternative immunosuppressive agents in cases of CSrefractory COP. Some reports suggest that early treatment with CPM can be effective, particularly in patients who fail to respond to treatment with CS alone (12). The administration of CyA together with a CS in a fulminant patient with COP resulted in a successful outcome (13).…”