Kim Sei Won, Rhee Chin Kook, Kim Yoo Jin, Lee Seok, Kim Hee Je, Lee Jong Wook
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Respir Res. 2016 May 26;17(1):63. doi: 10.1186/s12931-016-0380-1.
Bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (HSCT) is currently treated with systemic corticosteroids despite poor efficacy and side effects. This study investigated the therapeutic effect of budesonide/formoterol, montelukast and n-acetylcysteine, which are suggested as treatment options for BOS after HSCT.
After diagnosis of BOS, 61 patients were treated with budesonide/formoterol, montelukast and n-acetylcysteine for 3 months. Pulmonary function test and COPD assessment test (CAT) were performed before and after the combination therapy. Therapeutic response was evaluated by changes in forced expiratory volume in 1 s (FEV1) or CAT score.
After 3 months of combination treatment, mean FEV1 increased by 220 mL (p < 0.001) and residual volume decreased by 200 mL (p =0 .005). Median CAT score also significantly decreased from 15.5 to 11.0 (p = 0.001). The overall response rate to combination therapy was 82 %. Comparing the no-response group and the response group, the forced vital capacity (% predicted) decline between pre-HSCT and BOS diagnosis was significantly greater in the response group (p = 0.036).
Combination treatment with budesonide/formoterol, montelukast and n-acetylcysteine significantly improved lung function and respiratory symptoms in patients with BOS after allogeneic HSCT without serious side effects.
异基因造血干细胞移植（HSCT）后闭塞性细支气管炎综合征（BOS）目前采用全身用糖皮质激素治疗，尽管疗效不佳且有副作用。本研究调查了布地奈德/福莫特罗、孟鲁司特和N-乙酰半胱氨酸对HSCT后BOS的治疗效果，这些药物被建议作为BOS的治疗选择。
61例BOS诊断患者接受布地奈德/福莫特罗、孟鲁司特和N-乙酰半胱氨酸治疗3个月。联合治疗前后进行肺功能测试和慢性阻塞性肺疾病评估测试（CAT）。通过1秒用力呼气量（FEV1）或CAT评分的变化评估治疗反应。
联合治疗3个月后，平均FEV1增加220 mL（p<0.001），残气量减少200 mL（p =0.005）。CAT评分中位数也从15.5显著降至11.0（p =0.001）。联合治疗的总有效率为82%。比较无反应组和反应组，反应组HSCT前至BOS诊断时用力肺活量（预测值%）下降幅度显著更大（p =0.036）。
布地奈德/福莫特罗、孟鲁司特和N-乙酰半胱氨酸联合治疗显著改善了异基因HSCT后BOS患者的肺功能和呼吸道症状，且无严重副作用。
