Increasing immunosuppression despite high load of respiratory viruses: Fludarabine as rescue treatment in alloreactive lung disease

Ref ID: 18404

Author:

Bart Rottier , Martine Raphael, Jan Jaap Boelens

Author address:

Beatrix Children’s Hospital,
University Medical Center Groningen, Groningen, Netherlands; Wilhelmina
Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands

Full conference title:

European Respiratory Congress

Abstract:

Background: Allo immune lung syndromes (alloLS) as Bronchiolitis obliterans
syndrome and ideopathic pulmonary syndrome are life threatening complications
after allogenic hematopoetic stem cell transplantation (HSCT) or lungtransplantation
(LTX; rejection). Respiratory viral infections may trigger these alloLS. If
conventional treatment with corticosteroids is not effective, 2nd line therapy may
be needed.
Aim: To describe safety and efficacy of the T-cell depleting agent fludarabine to
treat allo immuneLS in the presence of viral infections
Methods: We describe 5 patients (4 HSCT, 1 LTX) with steroid refractory alloLS
who were therefore treated with fludarabine 30mg/m2 on a 3 weekly basis. Viral
persistence of respiratory viruses was monitored by quantitative PCR before and
during treatment.
Results: The five patients all initially had good engraftment, but developed respiratory
complications. 4 patients were positive in BAL and/or nasopharyngeal
aspirate with cycle threshold (CT values <30 for: rhinovirus (2), parainfluenza and RSV (1) and adenovirus (1)). 4/5 patients had initial response after mean 2.4 (range 1-4) courses. The LTX patient improved clinically as well as for FEV1 for 2 months and then had a relapse with progression of the alloLS. One patient died from aspergillus after 2 months. 3 patients had sustained response. Viral load (expressed in CT values) remained high in all patients, without occurrence of systemic disease. Conclusions: Fludarabine is feasible and an effective 2nd line treatment of steroid refractory allo immune lung syndromes, without an increase in viral load. This empirical treatment now deserves a controlled study.

Abstract Number: P1149

Conference Year: 2011

Link to conference website: http://www.ers-education.org/ersMade/abstract_print_11/files/Abstract_book_2011.pdf

New link: NULL

Conference abstracts, posters & presentations

Showing 10 posts of 17325 posts found.

  • Title

    Author

    Year

    Number

    Poster