Christian Benden1, Maria Haughton2, Saoirse Leonard2, Lars C Huber3. 1. Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland. Electronic address: christian_benden@yahoo.de. 2. Costello Medical Consulting, Cambridge, United Kingdom. 3. Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Abstract
BACKGROUND: Long-term success of lung transplantation is limited by the development of chronic lung allograft dysfunction (CLAD), of which bronchiolitis obliterans syndrome (BOS) is the most common form. This systematic review sought to identify the current evidence base for CLAD-BOS therapies after initial immunosuppressive treatment strategies. METHODS: The MEDLINE, Embase, and Cochrane Library databases from inception to May 3, 2016, were searched using keywords relating to CLAD-BOS, study designs, and treatments of interest, including extracorporeal photopheresis (ECP), aerosolized cyclosporine, total lymphoid irradiation (TLI), alemtuzumab, and montelukast. Titles, abstracts, and full texts were screened by 2 independent reviewers to identify studies of CLAD-BOS second-line therapy in adult lung transplant patients. Quality was assessed according to the Downs and Black checklist. RESULTS: Of the 936 individual citations identified, 47 reports of 40 studies met inclusion criteria, including 17 full publications, 11 recent (2015-2016), and 12 older (pre-2015) congress proceedings. Most of the full publications and recent abstracts investigated ECP (n = 11), TLI (n = 5), alemtuzumab (n = 4), and montelukast (n = 2). Most studies were uncontrolled and retrospective. Compared with standard therapy alone, improved lung function and survival was reported for ECP in 2 studies without randomization, with lower-quality evidence for improved lung function for TLI, montelukast, and aerosolized cyclosporine. CONCLUSIONS: Because most identified studies were of retrospective and uncontrolled design, comparison of treatment effects was limited. Available evidence suggests stabilized lung function after ECP in combination with established immunosuppressive regimens in late-line CLAD-BOS treatment, with fewer data for TLI, montelukast, and aerosolized cyclosporine.
BACKGROUND: Long-term success of lung transplantation is limited by the development of chronic lung allograft dysfunction (CLAD), of which bronchiolitis obliterans syndrome (BOS) is the most common form. This systematic review sought to identify the current evidence base for CLAD-BOS therapies after initial immunosuppressive treatment strategies. METHODS: The MEDLINE, Embase, and Cochrane Library databases from inception to May 3, 2016, were searched using keywords relating to CLAD-BOS, study designs, and treatments of interest, including extracorporeal photopheresis (ECP), aerosolized cyclosporine, total lymphoid irradiation (TLI), alemtuzumab, and montelukast. Titles, abstracts, and full texts were screened by 2 independent reviewers to identify studies of CLAD-BOS second-line therapy in adult lung transplant patients. Quality was assessed according to the Downs and Black checklist. RESULTS: Of the 936 individual citations identified, 47 reports of 40 studies met inclusion criteria, including 17 full publications, 11 recent (2015-2016), and 12 older (pre-2015) congress proceedings. Most of the full publications and recent abstracts investigated ECP (n = 11), TLI (n = 5), alemtuzumab (n = 4), and montelukast (n = 2). Most studies were uncontrolled and retrospective. Compared with standard therapy alone, improved lung function and survival was reported for ECP in 2 studies without randomization, with lower-quality evidence for improved lung function for TLI, montelukast, and aerosolized cyclosporine. CONCLUSIONS: Because most identified studies were of retrospective and uncontrolled design, comparison of treatment effects was limited. Available evidence suggests stabilized lung function after ECP in combination with established immunosuppressive regimens in late-line CLAD-BOS treatment, with fewer data for TLI, montelukast, and aerosolized cyclosporine.
Authors: Jason M Gauthier; Daniel Ruiz-Pérez; Wenjun Li; Ramsey R Hachem; Varun Puri; Andrew E Gelman; Daniel Kreisel Journal: Transplantation Date: 2018-09 Impact factor: 4.939
Authors: Virginia Escamilla Gómez; Valentín García-Gutiérrez; Lucía López Corral; Irene García Cadenas; Ariadna Pérez Martínez; Francisco J Márquez Malaver; Teresa Caballero-Velázquez; Pedro A González Sierra; María C Viguria Alegría; Ingrid M Parra Salinas; Cristina Calderón Cabrera; Marta González Vicent; Nancy Rodríguez Torres; Rocío Parody Porras; Christelle Ferra Coll; Guillermo Orti; David Valcárcel Ferreiras; Rafael De la Cámara LLanzá; Paula Molés; Kyra Velázquez-Kennedy; María João Mende; Dolores Caballero Barrigón; Estefanía Pérez; Rodrigo Martino Bofarull; Silvanna Saavedra Gerosa; Jorge Sierra; Marc Poch; María T Zudaire Ripa; Miguel A Díaz Pérez; Blanca Molina Angulo; Isabel Sánchez Ortega; Jaime Sanz Caballer; Juan Montoro Gómez; Ildefonso Espigado Tocino; José A Pérez-Simón Journal: Bone Marrow Transplant Date: 2019-11-07 Impact factor: 5.483