在两种自动光分离置换术仪器之间比较了体外光分离置换术阻止肺移植受者闭塞性细支气管炎的疗效。

The efficacy of extracorporeal photopheresis to arrest bronchiolitis obliterans in lung allograft recipients was compared between two automated photopheresis instruments.

作者信息

Chionis Lisa, Grossman Brenda J, Hachem Ramsey, Commean Paul, Derfler Mary Clare, Vedantham Suresh, Dodds Kathy, Spitznagel Edward, Atkinson Jeff, Despotis George

机构信息

Washington University, St Louis, Missouri.

Department of Pathology & Immunology, Division of Laboratory & Genomic Medicine, Washington University School of Medicine, St Louis, Missouri.

出版信息

Transfusion. 2018 Dec;58(12):2933-2941. doi: 10.1111/trf.14913. Epub 2018 Oct 12.

DOI:10.1111/trf.14913

PMID:30312482

Abstract

BACKGROUND

The most common instruments used for extracorporeal photopheresis (ECP) treatment in the United States are the UVAR XTS and the CELLEX devices (Therakos, West Chester, PA). When compared to the UVAR XTS instrument, the efficacy of the CELLEX instrument to arrest the decline in lung function in patients with chronic lung allograft dysfunction (CLAD) related to bronchiolitis obliterans (BOS) has not been previously evaluated.

METHODS

The relative efficacy of the CELLEX vs UVAR XTS ECP instruments was assessed by comparing the difference in rates of FEV decline before and after ECP treatment and survival in two series of lung allograft recipients with BOS who had been treated with these instruments.

RESULTS

Similar Slope Difference values for change in rate of decline (6 months Post ECP - Pre ECP) were observed between the two cohorts (UVAR XTS: 85 ± 109 mL/month vs CELLEX: 76 ± 128 mL/month, p=0.72). A similar percentage of patients responded to ECP (UVAR XTS: 77% vs CELLEX: 89%; p=0.36) i.e., as defined as a positive difference in slope between the rate of decline of FEV before and 6 months after ECP. Survival at either 6 (p=0.89) or 12 (p=0.8) months after the start of ECP was not associated with instrument used despite a trend in higher early mortality (34% vs 17%, p=0.054) in the patients who were predominately treated with the CELLEX.

CONCLUSIONS

Our data support the use of the CELLEX for prospective studies designed to evaluate the merits of ECP in this population.

摘要

背景

在美国，用于体外光化学疗法（ECP）治疗的最常用仪器是UVAR XTS和CELLEX设备（Therakos公司，宾夕法尼亚州韦斯特切斯特）。与UVAR XTS仪器相比，CELLEX仪器对患有与闭塞性细支气管炎（BOS）相关的慢性肺移植功能障碍（CLAD）患者的肺功能下降的抑制效果此前尚未得到评估。

方法

通过比较两组接受过这些仪器治疗的BOS肺移植受者在ECP治疗前后FEV下降率的差异以及生存率，评估CELLEX与UVAR XTS ECP仪器的相对疗效。

结果

两个队列之间观察到相似的下降率变化斜率差值（ECP后6个月 - 治疗前）（UVAR XTS：85±109 mL/月 vs CELLEX：76±128 mL/月，p = 0.72）。相似比例的患者对ECP有反应（UVAR XTS：77% vs CELLEX：89%；p = 0.36），即定义为ECP前和ECP后6个月FEV下降率之间斜率的正差值。尽管主要接受CELLEX治疗的患者早期死亡率有更高的趋势（34% vs 17%，p = 0.054），但在ECP开始后6个月（p = 0.89）或12个月（p = 0.8）的生存率与使用的仪器无关。