Comparison of Extracorporeal Photopheresis and Alemtuzumab for the Treatment of Chronic Lung Allograft Dysfunction

Background Survival following lung transplantation is limited by chronic lung allograft dysfunction (CLAD). Immunomodulatory therapies such as extracorporeal photopheresis (ECP) and alemtuzumab (AL) have been described for refractory CLAD, but comparative outcomes are not well defined. Methods We re...

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Veröffentlicht in:The Journal of heart and lung transplantation 2018-03, Vol.37 (3), p.340-348
Hauptverfasser: Moniodis, Anna, MD, Townsend, Keri, Pharm D, Rabin, Alexander, MD, Aloum, Obadah, MD, Stempel, Jessica, MD, Burkett, Patrick, MD, PhD, Camp, Phillip, MD, Divo, Miguel, MD, El-Chemaly, Souheil, MD,MPH, Mallidi, Hari, MD, Rosas, Ivan, MD, Fuhlbrigge, Anne, MD, MSc, Koo, Sophia, MD, MPH, Goldberg, Hilary J., MD, MPH
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Sprache:eng
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Zusammenfassung:Background Survival following lung transplantation is limited by chronic lung allograft dysfunction (CLAD). Immunomodulatory therapies such as extracorporeal photopheresis (ECP) and alemtuzumab (AL) have been described for refractory CLAD, but comparative outcomes are not well defined. Methods We retrospectively reviewed spirometric values and clinical outcomes after therapy with ECP, AL or no treatment in patients transplanted between 1/2005-12/2014 who were diagnosed with CLAD. We used inverse probability-weighted regression adjustment (IPWRA) to adjust for potential confounders affecting treatment choice. Results Of 267 transplanted patients, 31 received immunomodulatory therapies for CLAD, and 78 no treatment. The slope of FEV1 decline significantly improved after treatment with AL and with ECP compared to pre-treatment FEV1 slope, however there was no significant change in slope of FVC. Comparison to a no treatment group was limited due to clinical differences in the treatment groups. After IPWRA, we found no significant difference in the mean difference of FEV1 slope (mL/month) when comparing treatment to no treatment, suggesting stabilization of lung function in the treatment group. We found no difference between the two immunomodulatory therapies 1, 3 or 6 months post-treatment (-49.9 [95% CI: -581.8, +482.0], p=0.85; +27.7 [95% CI: -167.6, +223.0], p=0.78; -9.6 [95% CI: -167.5, +148.2], p=0.91, respectively). We also found no difference in mean FVC slope or differences between ECP and AL in infection rates or survival following treatment. Conclusion Immunomodulatory therapy for CLAD with ECP or AL was associated with a significant change in FEV1 slope post-treatment, compared to pre-treatment slope, with minimal effect on FVC. There was no difference between the two therapies in their effect on pulmonary function.
ISSN:1053-2498
1557-3117
DOI:10.1016/j.healun.2017.03.017