title: Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation.
abstract: Post transplantation constrictive bronchiolitis (PTCB) is the most common pulmonary complication among long-term survivors of allogeneic hematopoietic stem cell transplantation (HSCT). It is a late manifestation of GVHD. Its treatment with high-dose systemic corticosteroids and other immunosuppressive regimens is associated with multiple side effects. Topical corticosteroids are used for the treatment of other manifestations of GVHD to minimize these side effects. We conducted a retrospective analysis of a series of adult patients to evaluate the efficacy of high-dose inhaled corticosteroids in the treatment of PTCB. Seventeen patients with new-onset airflow obstruction were diagnosed with PTCB. Their forced expiratory volume in 1 s (FEV1) declined from a median of 84% (range, 56-119) before HSCT to 53% (26-82) after HSCT. All patients received inhaled fluticasone propionate 500-940 microg two times daily. Symptoms of airway obstruction improved and FEV1 stabilized 3-6 months after treatment. We conclude that high-dose inhaled corticosteroids may be effective in the treatment of PTCB and propose a plausible mechanism of its action. A prospective evaluation of its efficacy is warranted.
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. lbashoura@mdanderson.org
authors.forename: L
authors.initials: L
authors.lastname: Bashoura
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.forename: A
authors.initials: A
authors.lastname: Jain
authors.forename: D R
authors.initials: DR
authors.lastname: Couriel
authors.forename: K V
authors.initials: KV
authors.lastname: Komanduri
authors.forename: G A
authors.initials: GA
authors.lastname: Eapen
authors.forename: A
authors.initials: A
authors.lastname: Safdar
authors.forename: K R
authors.initials: KR
authors.lastname: Broglio
authors.forename: R
authors.initials: R
authors.lastname: Adachi
authors.forename: B F
authors.initials: BF
authors.lastname: Dickey
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D001988:Bronchiolitis / Q000188:drug therapy*; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones