Effect of Ruxolitinib on Lung Function after Allogeneic Stem Cell Transplantation

Area of Science:

• Hematology
• Immunology
• Pulmonology

Background:

• Sclerotic chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) can cause lung function impairment.
• Bronchiolitis obliterans syndrome (BOS) and restrictive lung disease (RLD) are common complications of severe skin cGVHD.
• No current treatments have demonstrated efficacy in improving lung function in this patient population.

Purpose of the Study:

• To retrospectively assess the effect of ruxolitinib on lung function in patients with sclerotic skin cGVHD.
• To evaluate changes in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) trajectories following ruxolitinib treatment.
• To determine if ruxolitinib can mitigate lung function decline in cGVHD patients.

Main Methods:

• A retrospective analysis of 70 patients with sclerotic skin cGVHD between March 2015 and April 2018.
• Propensity score matching (1:1) was used to balance confounding factors between 36 ruxolitinib-exposed and 34 unexposed patients.
• Linear mixed-effects models compared FVC and FEV1 trajectories in matched patients over a median follow-up of 58 months.

Main Results:

• FEV1 significantly decreased over time in all patients, irrespective of ruxolitinib exposure (P < .0001).
• The trajectory of FEV1 decline was similar between the ruxolitinib-exposed and unexposed groups (P = .11).
• No significant difference in the progression of lung function was observed between the groups.

Conclusions:

• Ruxolitinib administration did not show a benefit in improving or stabilizing respiratory function in allogeneic HSCT recipients with sclerotic skin cGVHD.
• The study suggests that ruxolitinib may not be effective in altering the natural course of lung function impairment in this specific cGVHD subtype.
• Further research may be needed to explore alternative therapeutic strategies for lung complications in cGVHD.