Fluticasone, azithromycin and montelukast therapy in reducing corticosteroid exposure in bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: a case series of eight patients

Abstract

Backround Bronchiolitis obliterans syndrome (BOS) is a devastating pulmonary complication affecting long term survivors of allogeneic hematopoietic cell transplantation. Treatment of BOS with prolonged courses of high dose corticosteroids is often associated with significant morbidity. Reducing the exposure to corticosteroids may reduce treatment related morbidity. Our institution has recently begun to treat patients with emerging therapies in an effort to diminish steroid exposure. Methods We retrospectively reviewed the 6-month corticosteroid exposure, lung function, and failure rates in 8 patients with newly diagnosed BOS who were treated with a combination of fluticasone, azithromycin and montelukast (FAM) and a rapid corticosteroid taper. These patients were compared to 14 matched historical patients who received high dose corticosteroids followed by a standard taper. Results The median 6-month prednisone exposure in FAM-treated patients was 1819 mg [0 mg to 4036 mg] compared to 7163 mg [6551 mg to 7829 mg] in the control group (p = 0.002). The median FEV1 change in FAM-treated patients was 2% [−3% to 4%] compared to 1% [−4 to 5%] in the control group (p = 1.0). Discussion Prednisone exposure in FAM patients was one quarter that of a retrospective matched group of patients, with minimal change in median FEV1, suggesting that BOS may be spared of the morbidities associated with long-term corticosteroid use by using alternative agents with less side effects.

Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosis

“…[15][16][17][18][19] Our results strongly support the investigation of new therapeutic approaches for the management of BOS. In this context, prospective trials are currently ongoing (formoterol/budesonide, France, NCT00624754; montelukast, USA, NCT00656058; combined azithromycin, N-acetylcysteine, and inhaled corticosteroids, Korea, NCT01327625; fluticasone propionate, azithromycin and montelukast sodium combination (FAM), USA, NCT01307462).…”

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

“…A recently published case-series indicates a steroid sparing effect of azithromycin in combination with inhaled corticosteroids and montelukast in patients with newly diagnosed BO. 85 Further studies are needed to establish an eventual effect of azythromycin on incipient BO.…”

Efeito anti-inflamatório dos macrolídeos em doenças pulmonares da infância

“…Treatment with azithromycin had positive effects, such as a 21% improvement in FVC and a 20% improvement in FEV 1 . Another case study (34) also reported positive effects, although a randomized clinical trial found no differences in the results between the placebo and azithromycin groups. of the disease but not in the fibroproliferative type.…”