Influence of oral beclomethasone dipropionate on early non-infectious pulmonary outcomes after allogeneic hematopoietic cell transplantation: results from two randomized trials.

Publication Type:

Journal Article

Authors:

Chien, J W; Sakai, M; Gooley, Theodore A; Schoch, H G; McDonald, George B

Source:

Bone marrow transplantation, Volume 45, Issue 2, p.317-24 (2010)

Keywords:

2010, Adolescent, Aged, Beclomethasone, Center-Authored Paper, Child, Clinical Research Division, Female, Graft vs Host Disease, hematopoietic stem cell transplantation, Humans, Lung Diseases, Lung Diseases, Fungal, Male, Middle Aged, Research Trials Office Core Facility - Biostatistics Service, Respiratory Function Tests, Shared Resources

Abstract:

Early non-infectious pulmonary complications represent a significant cause of mortality after hematopoietic cell transplantation (HCT). We tested the hypothesis that oral beclomethasone dipropionate (BDP) is effective for preventing early non-infectious pulmonary complications after allogeneic HCT. We retrospectively reviewed the medical records of 120 patients, 60 in each treatment arm, to identify non-infectious and infectious pulmonary events and pulmonary function test results from all patients who participated in two randomized trials of oral BDP for treatment of acute gastrointestinal GVHD. 17-Beclomethasone monopropionate (17-BMP), the active metabolite of BDP, was evaluated in blood from the right atrium in four patients. Thirty-three of 42 (79%) placebo-treated patients experienced a decrease of the DL(CO) from pretransplant to day 80 after transplant, compared with 27 of 49 (55%) BDP-treated patients (P=0.02). In the first 200 days after randomization, there were no cases of non-infectious pulmonary complications in BDP-treated patients, vs four cases among placebo-treated patients (P=0.04). Levels of 17-BMP were detected in atrial blood at steady state. Delivery of a potent glucocorticoid such as 17-BMP to the pulmonary artery after oral dosing of BDP may be useful in modulating pulmonary inflammation and preventing the development of non-infectious pulmonary complications after allogeneic HCT.