BACKGROUND: Extracorporeal photochemotherapy (ECP) for chronic lung allograft dysfunction (CLAD) has been reported as beneficial in a few short-term studies. OBJECTIVES: In this retrospective cohort study on 48 CLAD patients treated by ECP (off-line technique) for a period of >8 years (compared to 58 controls), we explored potential predictors of survival and response. METHODS: Failures were defined as a decrease in forced expiratory volume in 1 s (FEV1) of >10% from ECP initiation. RESULTS: ECP patients were enrolled between February 2003 and December 2013; 14 (29.2%) with restrictive allograft syndrome (RAS) and 34 with bronchiolitis obliterans syndrome. Grade 1 severity was indicated in 58.3%, grade 2 in 20.8%, and grade 3 in 20.8% of patients. The median follow-up was 65 months (cumulative 2,284.4 person-months). Twenty (41.7%) patients died, including 17 (85%) CLAD-related deaths. Among the controls, there were 42 deaths (72.4%), of which 32 (76.2%) were CLAD related, over a median of 51 months (cumulative 3,066.5 person-months; p = 0.09). Among ECP patients, the FEV1 slope flattened out after a decline in the initial months (slope -19 ml/month in months 0-6, +4 in months 36-48 and later; p = 0.001). RAS was associated with poorer survival, whereas a 'rapid decline in the previous 6 months' was not. No ECP side effects or complications were observed. CONCLUSION: Long-term ECP for CLAD is safe and reduces FEV1 decline over time; the RAS phenotype might show a poorer response. ECP deserves to be evaluated in a randomized controlled trial.
BACKGROUND: Extracorporeal photochemotherapy (ECP) for chronic lung allograft dysfunction (CLAD) has been reported as beneficial in a few short-term studies. OBJECTIVES: In this retrospective cohort study on 48 CLAD patients treated by ECP (off-line technique) for a period of >8 years (compared to 58 controls), we explored potential predictors of survival and response. METHODS: Failures were defined as a decrease in forced expiratory volume in 1 s (FEV1) of >10% from ECP initiation. RESULTS: ECP patients were enrolled between February 2003 and December 2013; 14 (29.2%) with restrictive allograft syndrome (RAS) and 34 with bronchiolitis obliterans syndrome. Grade 1 severity was indicated in 58.3%, grade 2 in 20.8%, and grade 3 in 20.8% of patients. The median follow-up was 65 months (cumulative 2,284.4 person-months). Twenty (41.7%) patients died, including 17 (85%) CLAD-related deaths. Among the controls, there were 42 deaths (72.4%), of which 32 (76.2%) were CLAD related, over a median of 51 months (cumulative 3,066.5 person-months; p = 0.09). Among ECP patients, the FEV1 slope flattened out after a decline in the initial months (slope -19 ml/month in months 0-6, +4 in months 36-48 and later; p = 0.001). RAS was associated with poorer survival, whereas a 'rapid decline in the previous 6 months' was not. No ECP side effects or complications were observed. CONCLUSION: Long-term ECP for CLAD is safe and reduces FEV1 decline over time; the RAS phenotype might show a poorer response. ECP deserves to be evaluated in a randomized controlled trial.
Authors: C Del Fante; T Galasso; P Bernasconi; L Scudeller; F Ripamonti; C Perotti; F Meloni Journal: Bone Marrow Transplant Date: 2016-01-04 Impact factor: 5.483
Authors: Arun Alfred; Peter C Taylor; Fiona Dignan; Khaled El-Ghariani; James Griffin; Andrew R Gennery; Denise Bonney; Emma Das-Gupta; Sarah Lawson; Ram K Malladi; Kenneth W Douglas; Tracey Maher; Julie Guest; Laura Hartlett; Andrew J Fisher; Fiona Child; Julia J Scarisbrick Journal: Br J Haematol Date: 2017-02-21 Impact factor: 6.998
Authors: Ashwini Arjuna; Michael T Olson; Rajat Walia; Ross M Bremner; Michael A Smith; Thalachallour Mohanakumar Journal: Expert Rev Respir Med Date: 2020-10-25 Impact factor: 3.772