Therapy options for chronic lung allograft dysfunction–bronchiolitis obliterans syndrome following first-line immunosuppressive strategies: A systematic review

A paired trial comparing mononuclear cell collection in two machines for further inactivation through an inline or offline extracorporeal photopheresis procedure

“…E xtracorporeal photopheresis (ECP) is effective for treating bronchiolitis obliterans (BO), which presents as cell rejection in lung transplant patients, as well as graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT). [1][2][3] Although its clinical efficacy has been proven, factors about ECP still remain unclear: first, its exact physiologic mechanism of action; second, the minimum number of cells that must be treated for ECP to be effective 4,5 ; third, the treatment regimens (number of ECP days per cycle) required for effective ECP treatment; and fourth, whether an integrated or inline ECP protocol is better than a multistep or offline ECP system. Our study focused on the fourth issue but also suggests some hypotheses to try to resolve the second and third factors.…”

“…7 In spite of this, some clinical inferences are feasible from our analysis that confirm the clinical efficacy of our multistep protocol and other studies that confirm the one-step efficacy of the Cellex protocol. 1 Another weakness of the study that deserves some comments is that it was performed during the implementation in our center of the one-step system, in contrast to the multistep system that was well known by our staff. However, we think this limitation had only a slight effect on the results and conclusions obtained from the study.…”

“…A paired trial comparing mononuclear cell collection in two machines for further inactivation through an inline or offline extracorporeal photopheresis procedure José-Luis Bueno, 1 Rosalía Alonso, 1 Clara Gonzalez-Santillana, 1 Daniel Naya, 1 Irene Romera, 1 Ana Alarcón, 1 Myriam Aguilar, 2 Guiomar Bautista, 1 Rafael Duarte, 1 Piedad Ussetti, 2 and José Rafael Cabrera 1 BACKGROUND: Extracorporeal photopheresis (ECP) is an effective treatment. However, protocols differ widely, and some questions, such as the number of cells to be collected or the number of ECP treatment days per treatment cycle, are still unsolved.…”

Montelukast in chronic lung allograft dysfunction after lung transplantation

“…39 However, their BOS cohort included mainly single lung recipients with native lung emphysema, so their findings may need confirmation in bilateral lung recipients with CLAD, even though CLAD progression over time (especially in rapid decliners and RAS patients) is now commonly reported in most LTx centers. 3,11,13 In most of the patients in our study the rate of FEV 1 (and FVC) decline was already significantly attenuated after 3 months of MLK, with improved FEV 1 in a significant number of CLAD patients. These findings were corroborated in the smaller cohort of patients for whom MLK was initiated for CLAD ≤3 months after previous start of azithromycin (n = 54; compare Figure S1B vs Figure S6B online).…”

“…8 Other therapeutic options for CLAD (particularly BOS) include total lymphoid irradiation (TLI) 9,10 or extracorporeal photopheresis (ECP). 11,12 TLI may reduce the rate of decline in graft function associated with BOS, particularly in "rapid decliners" (i.e., with forced expiratory volume in 1 second [FEV 1 ] decline >100 ml/month pre-TLI). 9,10 Similar effects have been seen with ECP, but mostly in BOS patients with a slowly progressive FEV 1 decline and increased airway lavage neutrophilia, whereas ECP is less likely to attenuate disease progression in rapid decliners (FEV 1 decline >100 ml/month pre-ECP), in BOS patients with low airway neutrophilia, and in patients with RAS, who, consequently, have the worst outcome after CLAD onset.…”