Scientific Letter
Radiological Improvement of Bronchiolitis Obliterans Following Hematopoietic Stem Cell Transplantation in a Patient Treated With Ruxolitinib
Mejoría de la bronquiolitis constrictiva tras trasplante de progenitores hematopoyéticos: demostración radiológica en paciente tratado con ruxolitinib
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A Colonizer or a True Pathogen?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "639" "paginaFinal" => "640" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Mycobacterium lentiflavum</span> en pacientes con fibrosis quística: ¿colonizante o patogénico?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 518 "Ancho" => 1300 "Tamanyo" => 62692 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lung CTs of 2 patients with a diagnosis of <span class="elsevierStyleItalic">M. lentiflavum</span> infection. 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The areas of lower density correspond to air trapping. Chest minIP (Minimum Intensity Projection) CT axial (C) and coronal (D) images in expiration showing less heterogeneity and greater uniformity of the attenuation of the pulmonary parenchyma with compared to images (A) and (B).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Bronchiolitis obliterans (BO) after hematopoietic stem cell transplantation (HSCT) is a serious, potentially fatal complication, which appears in association with chronic graft-vs-host disease (GVHD).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Lung function testing, and to a lesser but growing extent, computed tomography (CT) are the most important diagnostic tests in the detection of post-HSCT BO.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Systemic corticosteroids remain the cornerstone of treatment, but one of the most important new therapies is ruxolitinib, a drug that is showing encouraging results in patients with GVHD.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 39-year-old man with a history of Stage IV diffuse large B-cell lymphoma treated with several lines of chemotherapy who, after achieving complete remission, underwent HSCT from a matched donor in April 2015. Ten months after the procedure, the patient developed GVHD with cutaneous, gastrointestinal and pulmonary manifestations that did not respond favorably to treatment with corticosteroids and extracorporeal photopheresis. Lung function tests prior to developing GVHD were normal, but subsequently showed an obstructive pattern of moderate intensity, with forced expiratory volume in 1 second (FEV1) 59% predicted value, forced vital capacity (FVC) 78%, and FEV1/FVC 68%, along with a 71% decrease in CO diffusion capacity from pre-GVHD values. Dynamic computed tomography (dCT) of the chest in inspiration and expiration showed extensive areas of air trapping in both lungs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B), while infectious complications were ruled out. Bronchoalveolar lavage revealed no opportunistic infections. Given these findings, a diagnosis of BO refractory to corticosteroids and extracorporeal photopheresis associated with post-HSCT GVHD was given. The patient received ruxolitinib and achieved progressive improvement of the GVHD manifestations, including BO. Four months after starting ruxolitinib, lung function tests showed significant improvement, with an increase in FEV1 (72%), FVC (80%), and FEV1/FVC (71%), although mild air trapping persisted on plethysmography, with a residual volume of 128% and residual volume/total lung capacity ratio of 127%. Reduced signs of air trapping in the expiratory phase were also observed on dCT 3 months after starting ruxolitinib (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">BO is the most common non-infectious pulmonary complication of HSCT (and among the most serious), and one of the most important risk factors is the presence of chronic GVHD. Clinical presentation of BO is often insidious, and symptoms are non-specific (cough, dyspnea), although 20% of patients can be asymptomatic.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The National Institutes of Health of the United States specify the following criteria for the diagnosis of post-HSCT BO: (1) demonstrated airflow obstruction (FEV1/FVC <0.7 and FEV1 <80% of predicted value); (2) air trapping on CT, residual volume >120% predicted or histological confirmation of BO; and (3) absence of respiratory tract infection.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The most common CT findings are: air trapping, thickening of the bronchial walls, mosaic attenuation pattern, and bronchial dilation.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The long-term prognosis of BO is generally poor (5-year survival ranges between 13% and 56%),<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and the aim of treatment is to prevent progression of airflow obstruction. Treatment with systemic corticosteroids continues to be the mainstay of BO treatment, although other therapeutic options have been used in combination with extracorporeal photopheresis, corticosteroids and/or inhaled bronchodilators, montelukast, ofatumumab, and bortezomib.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Ruxolitinib is a new targeted therapy that selectively inhibits Janus kinases which interfere in the synthesis of various cytokines and growth factors required for hematopoiesis and immune function; its efficacy in the treatment of corticosteroid-resistant GVHD has recently been demonstrated.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> In our case, the clinical benefit of ruxolitinib was noted in the first weeks after administration, with corresponding clinical, spirometric, and radiological improvements. Very few descriptions are available in the literature of cases of post-HSCT BO responding to treatment with ruxolitinib, and we believe that the case presented illustrates the benefit of this promising drug in patients with post-HSCT BO, while at the same time reminding us of the importance of dCT studies to correlate radiological findings with spirometry in these patients.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gorospe Sarasúa L, Chinea-Rodríguez A, Almonacid-Sánchez C, Almeida-Aróstegui NA. Mejoría de la bronquiolitis constrictiva tras trasplante de progenitores hematopoyéticos: demostración radiológica en paciente tratado con ruxolitinib. Arch Bronconeumol. 2018;54:640–642.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1023 "Ancho" => 1400 "Tamanyo" => 188747 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest minIP (Minimum Intensity Projection) CT axial (A) and coronal (B) images in expiration showing a marked mosaic attenuation pattern in the pulmonary parenchyma, with geographical regions of low density alternating with areas of greater attenuation. The areas of lower density correspond to air trapping. Chest minIP (Minimum Intensity Projection) CT axial (C) and coronal (D) images in expiration showing less heterogeneity and greater uniformity of the attenuation of the pulmonary parenchyma with compared to images (A) and (B).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchiolitis obliterans following haematopoietic stem cell transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.O. Soubani" 1 => "J.P. Uberti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Respir J" "fecha" => "2007" "volumen" => "29" "paginaInicial" => "1007" "paginaFinal" => "1019" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obliterative bronchiolitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.R. Aguilar" 1 => "A.P. Michelson" 2 => "W. Isakow" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Transplantation" "fecha" => "2016" "volumen" => "100" "paginaInicial" => "272" "paginaFinal" => "283" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ruxolitinib for the treatment of patients with steroid-refractory GVHD: an introduction to the REACH trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Jagasia" 1 => "R. Zeiser" 2 => "M. Arbushites" 3 => "P. Delaite" 4 => "B. Gadbaw" 5 => "N.V. Bubnoff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2217/imt-2017-0156" "Revista" => array:2 [ "tituloSerie" => "Immunotherapy" "fecha" => "2018" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchiolitis obliterans syndrome in adults after allogeneic stem cell transplantation – pathophysiology, diagnostics and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I.S. Grønningsæter" 1 => "G. Tsykunova" 2 => "K. Lilleeng" 3 => "A.B. Ahmed" 4 => "Ø. Bruserud" 5 => "H. Reikvam" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Expert Rev Clin Immunol" "fecha" => "2017" "volumen" => "13" "paginaInicial" => "553" "paginaFinal" => "569" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors associated with bronchiolitis obliterans syndrome and chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Gazourian" 1 => "A.J. Rogers" 2 => "R. Ibanga" 3 => "G.L. Weinhouse" 4 => "V. Pinto-Plata" 5 => "J. Ritz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Hematol" "fecha" => "2014" "volumen" => "89" "paginaInicial" => "404" "paginaFinal" => "409" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CT findings of late-onset noninfectious pulmonary complications in patients with pathologically proven graft-versus-host disease after allogeneic stem cell transplant" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Song" 1 => "C.A. Yi" 2 => "J. Han" 3 => "D.H. Kim" 4 => "K.S. Lee" 5 => "T.S. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2012" "volumen" => "199" "paginaInicial" => "581" "paginaFinal" => "587" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.M. Williams" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2017" "volumen" => "129" "paginaInicial" => "448" "paginaFinal" => "455" "itemHostRev" => array:3 [ "pii" => "S0140673600051837" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ruxolitinib: a steroid sparing agent in chronic graft-versus-host disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.J. Khoury" 1 => "A.A. Langston" 2 => "V.K. Kota" 3 => "J.A. Wilkinson" 4 => "I. Pusic" 5 => "A. Jillella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41409-017-0081-5" "Revista" => array:2 [ "tituloSerie" => "Bone Marrow Transplant" "fecha" => "2018" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Compassionate use of ruxolitinib in acute and chronic graft versus host disease refractory both to corticosteroids and extracorporeal photopheresis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.S. Maldonado" 1 => "P. Ramírez Villanueva" 2 => "P. Bertín Cortes-Monroy" 3 => "V. Jara Arias" 4 => "K. Soto Donoso" 5 => "P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 5 | 7 |
| 2024 October | 38 | 18 | 56 |
| 2024 September | 50 | 16 | 66 |
| 2024 August | 53 | 45 | 98 |
| 2024 July | 40 | 21 | 61 |
| 2024 June | 53 | 24 | 77 |
| 2024 May | 78 | 24 | 102 |
| 2024 April | 35 | 31 | 66 |
| 2024 March | 31 | 20 | 51 |
| 2024 February | 29 | 20 | 49 |
| 2023 March | 7 | 6 | 13 |
| 2023 February | 39 | 18 | 57 |
| 2023 January | 32 | 23 | 55 |
| 2022 December | 51 | 24 | 75 |
| 2022 November | 54 | 22 | 76 |
| 2022 October | 47 | 45 | 92 |
| 2022 September | 32 | 27 | 59 |
| 2022 August | 37 | 43 | 80 |
| 2022 July | 32 | 38 | 70 |
| 2022 June | 37 | 29 | 66 |
| 2022 May | 52 | 41 | 93 |
| 2022 April | 72 | 31 | 103 |
| 2022 March | 80 | 42 | 122 |
| 2022 February | 82 | 39 | 121 |
| 2022 January | 62 | 34 | 96 |
| 2021 December | 40 | 36 | 76 |
| 2021 November | 49 | 35 | 84 |
| 2021 October | 42 | 33 | 75 |
| 2021 September | 29 | 46 | 75 |
| 2021 August | 25 | 31 | 56 |
| 2021 July | 19 | 21 | 40 |
| 2021 June | 44 | 30 | 74 |
| 2021 May | 36 | 44 | 80 |
| 2021 April | 70 | 79 | 149 |
| 2021 March | 72 | 31 | 103 |
| 2021 February | 37 | 20 | 57 |
| 2021 January | 33 | 13 | 46 |
| 2020 December | 21 | 15 | 36 |
| 2020 March | 18 | 6 | 24 |
| 2020 February | 29 | 16 | 45 |
| 2020 January | 37 | 15 | 52 |
| 2019 December | 24 | 9 | 33 |
| 2019 November | 21 | 13 | 34 |
| 2019 October | 19 | 8 | 27 |
| 2019 September | 28 | 18 | 46 |
| 2019 August | 16 | 12 | 28 |
| 2019 July | 19 | 14 | 33 |
| 2019 June | 22 | 5 | 27 |
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