Factors Associated With Mortality and Response to Extracorporeal Photopheresis in Lung Allograft Recipients With Bronchiolitis Obliterans Syndrome

Background This study was designed to identify factors associated with clinical response to extracorporeal photopheresis (ECP) and mortality after ECP in lung allograft recipients with bronchiolitis obliterans (BOS). Methods FEV1 values obtained 6 months before (baseline) and 6 months after initiation of ECP were used to plot the linear relationship between FEV1 vs time before and after ECP. Response to ECP was assigned when a positive integer was derived after subtracting the baseline rate of decline from the rate of decline 6 months after ECP. Uni- and multivariate logistic regression analyses were used to identify demographic, treatment related factors or spirometric parameters and that may be associated with response to ECP or mortality at either 6 or 16 months after initiation of ECP. Results FEV1 just prior to ECP was associated with mortality (p=0.007) at 16 months after ECP initiation. An FEV1 ≤ 1.50L had a sensitivity of 87% and a specificity of 60% to identify patients who died within 16 months after ECP initiation. Patients whose FEV1 decline exceeded > 40 mL/month were 12 times more likely to have a response to ECP (p=0.0001). Patients whose decline in FEV1 before ECP was statistically significant (p40 mL/month) and statistical significance of the relationship between FEV1 vs time prior to ECP initiation. Therefore, earlier BOS detection and more timely implementation of ECP (ie, when FEV1 values > 1.5L) should be considered especially in patients with a more aggressive rate of decline of lung function. Correspondence: George Despotis, MD, Washington University School of Medicine, Department of Pathology & Immunology, Division of Laboratory & Genomic Medicine,425 S. Euclid Avenue, Campus Box 8118, Saint Louis, MO 63110. Email gjdespotis@wustl.edu Authorship Hope E. Karnes, MD, PhD: Participated in research design, performance of the research, writing of the paper, data analysis Emily I. Schindler, MD, PhD: Participated in research design, performance of the research, writing of the paper, data analysis Matt Morrell, MD: Participated in research design, performance of the research, writing of the paper, data analysis Ramsey R Hachem MD: Participated in research design, performance of the research, writing of the paper, data analysis Keith Berman, MPH, MPA: Participated in writing of the paper, data analysis Suresh Vedantham, MD: Participated in writing of the paper, data analysis Jeff Atkinson, MD: Participated in writing of the paper, data analysis Edward Spitznagel, PhD: Participated performance of the research, in writing of the paper, data analysis George Despotis, MD: Participated in research design, performance of the research, writing of the paper, data analysis Disclosure: Relationships with entities related to the topic are listed below: Hope E. Karnes, MD, PhD - None Emily I. Schindler, MD, PhD - None Matt Morrell, MD –Investigator for Investigator initiated grant from Therakos and Medicare for protocol Number CAG-00324R2 Ramsey Hachem, MD – Investigator for Investigator initiated grant from Therakos and Medicare for protocol Number CAG-00324R2, Served on advisory board for Theravance, Served on advisory board for Vectura, Serving on advisory board for Breath Keith Berman MPH, MBA: Consultant to Therakos and Barnes-Jewish Hospital Suresh Vedantham, MD – Investigator for Investigator initiated grant from Therakos and Medicare for protocol Number CAG-00324R2 Jeff Atkinson, MD - None Ed Spitznagel, PhD – Investigator for Investigator initiated grant from Therakos and Medicare for protocol Number CAG-00324R2 George Despotis, MD – Principle Investigator for Investigator initiated grant from Therakos and Medicare for protocol Number CAG-00324R2 Funding: No funding for the current work. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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