CHEST Guidelines-Tamibarotene-for-the-Treatment-of-Bronchiolitis-Ob (1)

Tamibarotene-for-the-Treatment-of-Bronchiolitis-Ob (1)

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The document describes a case study where Tamibarotene, a synthetic retinoid, was used to treat Bronchiolitis Obliterans (BO) associated with chronic graft-vs-host disease (cGVHD) in a patient post-allogeneic hematopoietic stem cell transplantation (allo-HSCT). The patient, a 47-year-old man with a history of acute promyelocytic leukemia (APL), exhibited significant improvement in lung function and cleared cutaneous manifestations of cGVHD following Tamibarotene treatment, despite BO's general resistance to corticosteroids and immunosuppressants and the lack of established treatment.<br /><br />Before Tamibarotene administration, the patient experienced severe symptoms like oral mucositis, dermatitis, and exertional dyspnea, with pulmonary function tests indicating airway obstruction. Tamibarotene was administered after other therapies, including inhaled corticosteroids and bronchodilators, showed no improvement. After starting Tamibarotene at a dosage of 10 mg/day, the patient's condition improved within three months, as evidenced by increased FEV1 (a measure of lung function).<br /><br />The case highlights BO as a significant impediment to long-term outcomes post-HSCT. Traditionally managed as part of the immune-mediated spectrum of cGVHD, BO’s pathophysiology involves different immune responses. Tamibarotene functions as an immune-regulator with potential benefits for BO by modulating Th1 and Th17 immune responses. Its chemical stability and fewer side effects compared to all-trans retinoic acid make it a promising option.<br /><br />The outcome suggests Tamibarotene as a viable treatment for BO related to cGVHD, warranting further clinical trials to assess its efficacy and potential application for other BO causes, including post-lung transplantation cases. The study concludes by calling for prospective controlled trials to further explore and validate Tamibarotene's therapeutic potential in improving patient prognosis in BO cases.

Keywords

Tamibarotene

Bronchiolitis Obliterans

chronic graft-vs-host disease

allo-HSCT

acute promyelocytic leukemia

lung function improvement

corticosteroid resistance

immune-regulator

Th1 and Th17 modulation

clinical trials