CHEST Guidelines-Tamibarotene-for-the-Treatment-of-Bronchiolitis-Ob

Tamibarotene-for-the-Treatment-of-Bronchiolitis-Ob

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The document discusses the case of bronchiolitis obliterans (BO) associated with chronic graft-vs-host disease (cGVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT). BO is a severe post-transplant pulmonary complication characterized by inflammation and fibrous obstruction of small airways, with limited treatment options. The report highlights the use of tamibarotene, a synthetic retinoid, which led to significant improvement in a 47-year-old male patient with biopsy-proven BO and cGVHD.<br /><br />The patient had a history of refractory acute promyelocytic leukemia (APL) and underwent two allo-HSCT procedures after multiple relapses. Despite achieving molecular remission, he developed BO, manifested by oral mucositis, dermatitis, and dyspnea. Conventional treatments including inhaled corticosteroids and bronchodilators showed no improvement on these symptoms or lung function. A diagnosis of moderate cGVHD involving mouth, skin, and lung was confirmed through lung biopsy.<br /><br />Tamibarotene, at a dosage of 10 mg/d, was administered alongside usual care but distinct from other immunosuppressive therapies. Within three months, marked improvements were observed in his respiratory function and symptoms. FEV1, a measure of airway obstruction, improved significantly, suggesting tamibarotene's potential efficacy in managing BO associated with cGVHD.<br /><br />The document underscores tamibarotene's advantages over other retinoids, citing its stability, potency, and fewer adverse effects. It calls for further clinical trials to confirm wide-ranging efficacy and considers its potential applicability in BO cases following lung transplantation and other causes.<br /><br />Overall, the report suggests that tamibarotene could represent a promising treatment avenue for patients with BO, offering improved lung function and symptom relief in cases unresponsive to traditional therapies.

Keywords

bronchiolitis obliterans

chronic graft-vs-host disease

allogeneic hematopoietic stem cell transplantation

tamibarotene

pulmonary complication

synthetic retinoid

acute promyelocytic leukemia

lung biopsy

respiratory function

clinical trials