Ip, MSM

Lam, CL

Lam, WK

Lie, AKW

Ooi, CGC

Tsang, KWT

HKU Scholars Hub

Title Bronchiolitis obliterans in bone marrow transplant recipients inHong KongAuthor(s) Lam, CL; Ip, MSM; Lam, WK; Tsang, KWT; Ooi, CGC; Lie, AKWCitation The 5th Medical Research Conference, Hong Kong, China,January 2000, v. 22 n. Supp 2, p. 22Issued Date 2000URL http://hdl.handle.net/10722/45737Rights Creative Commons: Attribution 3.0 Hong Kong LicenseG-RC-12BRONCHIOLITIS OBLITERANS IN BONE MARROW TRANSPLANT RECIPIENTS IN HONGKONG.CL Lam. MSM Ip, WK Lam, KWT Tsang, C Ooi, AKW Lie. Department of Medicine, The University ofHong Kong, Queen Mary Hospital, Hong Kong SAR, China.453 consecutive Chinese adult recipients of bone marrow transplant (BMT) (including 317 allogeneic BMT,42 matched-unrelated donor (MUD) BMT) for haematological diseases were followed with lung function testsbefore and after BMT at Days 90, 180, 360 and then annually plus additional tests if respiratory symptomsdeveloped or abnormal lung functions were detected. 37 patients (35 allogeneic and 2 MUD BMT) developedsignificant airflow obstruction compatible with bronchiolitis obliterans, including 20 male and 17 female patients.The haematological diagnoses at BMT were: acute myeloid leukaemia = 10, acute lymphoid leukaemia = 2,chronic myeloid leukaemia = 22, myelodysplastic syndrome - 2, kappa-light chain myeloma. Significantairflow obstruction was first detected on 351 ± 250 days after BMT. Most of these patients also had chronicgraft versus host disease involving the eyes, skin, liver and the gut despite having immunosuppressive therapy.Lung function at detection of airflow obstruction were: FEV, = 2.10± 0.67 L (76± 21 % of predicted), with a fallof 31± 19% compared to pre-BMT, FEV,/FVC = 68+ 11%, FEF25-75 = 1.47±0.76 L (37± 19% of predicted)with a fall of 57±24% compared to pre-BMT . Mean duration of follow-up was 45±30 months. 4 patients(11%) developed bronchiectasis after the onset of bronchiolitis obliterans as evidenced by high-resolution CTscan of thorax. 6 patients (16%) died with progressive respiratory failure. Surviving patients have static orworse lung functions compared to onset. In summary, there is a high incidence of bronchiolitis obliterans(11%) in allogeneic BMT recipients. Flow rates at low lung volumes is a sensitive parameter. The airflowobstruction remains static or deteriorate despite immunosuppressive and inhaled steroid therapy.G-RC-13COMBINATION OF PACLITAXEL AND CARBOPLATIN IN ADVANCED NON-SMALL CELLLUNG CANCER (NSCLC)Julie Wang. WK Lam, James Ho, C Yan, CL Lam, Simon Ip, FM Lam, Mary Ip, Kenneth Tsang. UniversityDepartment of Medicine, The University of Hong Kong, Hong Kong SARNSCLC is the major cause of cancer death in Hong Kong and almost always presents in very advanced stagesrendering curative treatment not feasible. NSCLC is increasingly being treated with chemotherapy althoughthere has not been consensus in the choice of currently available combinations of newer and more effectivetherapy. We have, therefore, studied the response rate and safety profile of paclitaxel and carboplatin inpatients with metastatic or locally advanced NSCLC in both chemotherapy-naive and previously treated stageIII and IV patients with good performance status. Patients with major organ failure, previous malignancies,active uncontrolled infection or definite contraindications for the use of corticosteroids were excluded. Paclitaxel175gm/m2 as 3hr IVI and carboplatin IVI AUC=6 over 30 mins. Were given in 3-weekly intervals for 6 cycles.Pre-medications with dexamethasone, cimetidine, and fluid hydration were given. Interim results were obtainedfrom 17 patients (4F) with age 59± 10.2 yrs. There were 12 adenocarcinomas and 2 undifferentiated NSCLC3 squamous cell CA with 6 in TNM stage IIIB and 11 in stage IV. The objective partial response rate after IIIcourse of chemotherapy occurred in 27% of patients 46% of cases had stable disease and 27% had progressivedisease after assessment for tumor size by two-dimensional measurements of chest x-rays or lymph node andbronchoscopic assessment. 5 out of 14 patient completed 6 courses of chemotherapy. The overall responserate is (33%), stable disease (33%) and progressive disease (33%). Adverse reactions including allergy (17%),hepatotoxicity (6%), thrombocytopenia (12%), and neutropenia (12%). There had been no treatment-relateddeath. The combination of paclitaxel and carboplatin appears to be a fairly well tolerated and highly effectiveregime in the treatment of advanced NSCLC. Further studies are warranted to evaluate the impact of thiscombination on the median term response and survival of these unfortunate patients.- 22 -

Bronchiolitis obliterans in bone marrow transplant recipients in Hong Kong

American Journal of Respiratory and Critical Care Medicine

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Bronchiolitis obliterans in bone marrow transplant recipients in Hong Kong

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