Bronchiolitis obliterans syndrome (BOS) is a common leading cause of morbidity and mortality in patients with organ transplant, particularly lung transplant and bone marrow transplantation.Current management therapies have shown no significant benefit and are associated with significant side effects.Azithromycin (macrolides) have proven anti-inflammatory effects and it has been used successfully in pan bronchiolitis and bronchiectasis.Ours if the first study asesing its effect in bos in patients with bone marrow transplant as part of graft vs host disease syndrome (GVHD).METHOD: All patients who received bone marrow transplant and developed BOS proven by obstructive pulmonary function test (PFT) findings and in some cases substantiated by specific high resolution ct chest findings (HRCT) of mosaic pattern or air trapping on inspiration and expiration HRCT, findings consistent with BOS.Baseline PFT and post BMT, OBS, PFT were reviewed, patients with existing obstructive airway disease prior to BMT were excluded.Azithromycin 500mgs daily x 3 days then 250mgs tiw was given for 3 months period. Patients were evaluated in clinic with follow-up PFTs at 6 weeks and 3 months effort was made to continue existing treatment for GVHD including steroids ans chemotherapeutic agents and not to make any changes in treatment after azithromycin was initiated.
Six (6) patients included in the study so far, four (4) showed improvement after addition of azithromycin to their treatment, one (1) stabilized with minimal improvement and one (1) patient showed deterioration in PFTs.
Azithromycin led to statistically significant improvement in pulmonary function in 5 of 6 patients with BOS post BMT (GHVD sydrome).CLINICAL IMPLICATION: A randomized trial of this promising, inexpensive and low risk treatment for BOS in post BMT patients and in-patients with other organ transplantation is warranted.
PatientsPre TreatmentPost Azirthromycin Treatment%Δ FVC%Δ FEV1FVCFEV1FVCFEV111.34L (49.8%)0.8 L (35.1%) 0.93L (35.1%)0.6L (26.9%)−Δ 14.7−Δ 8.222.27L1.14L 2.29L1.18L+ Δ .88+ Δ 3.530.64 (20.8)0.54 (20.7) 0.84 (24.6)0.71 (23.9)+ Δ 38.0+ Δ 32.042.41 (53.3)1.11 (29.3) 3.3 (73.0)1.25 (32.8)+ Δ 19.7+ Δ 3.551.06L0.6L 1.46L0.84L+ Δ 40.0+ Δ 37.461.25L1.05L 1.61L1.59L+ Δ 28.8+ Δ 51.4
Average Improvement %Δ FVC 18.76
Average Improvement % ΔFEV119.96
M. Khalid, None.