Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Respir Med. 2023 Nov;218:107410. doi: 10.1016/j.rmed.2023.107410. Epub 2023 Sep 9.
Bronchiolitis obliterans syndrome (BOS) is the lung manifestation of chronic graft-versus-host disease after hematopoietic stem cell transplantation (HSCT). We assessed whether inhaled tiotropium add-on to the combination regimen including budesonide/formoterol improve pulmonary function and the chronic obstructive pulmonary disease assessment test (CAT) scores in patients with BOS.
Post-HSCT patients diagnosed as BOS in Seoul St. Mary's Hospital were reviewed retrospectively. Patients defined as BOS and treated with budesonide/formoterol/tiotropium combination therapy after budesonide/formoterol therapy from January 2011 to June 2019 were enrolled.
Total of 86 patients were evaluated. After tiotropium add-on, the absolute FEV1 increased significantly from 1.47 ± 0.49 to 1.53 ± 0.57 L (p = 0.023) and the % predicted FEV1 from 45.0 ± 12.8 to 46.8 ± 14.5% (p = 0.031). The % predicted DLCO increased significantly after tiotropium add-on (from 61.6 ± 16.7 to 64.3 ± 16.3%, p = 0.028). Among 56 patients with complete CAT scores, no significant change was present in total CAT scores. In all, 30 of the 72 patients (41.7%) evidenced FEV1 increases > 100 mL, and 20 of 56 patients (35.7%) had CAT score decreases of ≥ 2 points. When the FEV1 and CAT scores were combined, the overall response rate to tiotropium add-on was 56.2% (41/73). The response group evidenced a significantly greater FVC increase, and a significant decrease in the RV/TLC ratio compared to the no-response group.
Inhaled tiotropium add-on to combination budesonide/formoterol significantly improved lung function, but not respiratory symptoms, in patients with post-HSCT BOS.
闭塞性细支气管炎综合征（BOS）是造血干细胞移植（HSCT）后慢性移植物抗宿主病的肺部表现。我们评估了吸入噻托溴铵联合布地奈德/福莫特罗治疗方案是否能改善 BOS 患者的肺功能和慢性阻塞性肺疾病评估测试（CAT）评分。
回顾性分析首尔圣玛丽医院诊断为 BOS 的 HSCT 后患者。从 2011 年 1 月至 2019 年 6 月，在布地奈德/福莫特罗治疗后开始使用布地奈德/福莫特罗/噻托溴铵联合治疗的 BOS 患者被纳入研究。
共评估了 86 例患者。噻托溴铵联合治疗后，绝对 FEV1 从 1.47±0.49 升增加到 1.53±0.57 升（p=0.023），FEV1%预计值从 45.0±12.8%增加到 46.8±14.5%（p=0.031）。噻托溴铵联合治疗后，预计 DLCO%显著增加（从 61.6±16.7%增加到 64.3±16.3%，p=0.028）。在 56 例有完整 CAT 评分的患者中，总 CAT 评分无显著变化。在所有患者中，72 例患者中有 30 例（41.7%）的 FEV1 增加量超过 100 毫升，56 例患者中有 20 例（35.7%）的 CAT 评分降低≥2 分。当 FEV1 和 CAT 评分相结合时，噻托溴铵联合治疗的总体反应率为 56.2%（41/73）。与无反应组相比，反应组的 FVC 增加更显著，RV/TLC 比值显著降低。
在 HSCT 后 BOS 患者中，吸入噻托溴铵联合布地奈德/福莫特罗治疗显著改善了肺功能，但对呼吸症状无改善。
