Respiratory medicine case reports
The use of dupilumab in bronchiolitis obliterans after hematopoietic stem cell transplant
Por Kyaw M, Lu K, Conrad D y 2 más.
Contenido en inglés
Resumen
Background
Bronchiolitis obliterans is a serious pulmonary manifestation of chronic graft-versus-host disease (cGVHD) following hematopoietic stem cell transplant (HSCT). Bronchiolitis obliterans is typically treated with a combination of inhaled steroids, azithromycin, montelukast and immunosuppressants. There are no curative treatments other than lung transplant, however, and additional therapies remain an unmet need.
Case presentation
Here we report two patients who developed bronchiolitis obliterans following HSCT. Both developed strong type 2 inflammatory markers including high eosinophil counts ≥ 1000 cells/mm3 and had history that was concerning for a possible concomitant asthma. Patient 1 had worsening symptoms after exposure to old wood during a construction project, and patient 2 had a history of asthma. Both patients were started on the anti-IL4 receptor monoclonal antibody, dupilumab, to target this type 2 inflammation. Both patients reported some symptomatic improvement but only had limited changes in their spirometry. Their courses were further complicated by multiple respiratory infections in the setting of immunosuppression for cGVHD.