Fluticasone, azithromycin and montelukast therapy in reducing corticosteroid exposure in bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: a case series of eight patients

Backround—Bronchiolitis obliterans syndrome (BOS) is a devastating pulmonary complication affecting long term survivors of allogeneic hematopoietic cell transplantation. Treatment of BOS with prolonged courses of high dose corticosteroids is often associated with significant morbidity. Reducing the exposure to corticosteroids may reduce treatment related morbidity. Our institution has recently begun to treat patients with emerging therapies in an effort to diminish steroid exposure. Methods—We retrospectively reviewed the 6-month corticosteroid exposure, lung function, and failure rates in 8 patients with newly diagnosed BOS who were treated with a combination of fluticasone, azithromycin and montelukast (FAM) and a rapid corticosteroid taper. These patients were compared to 14 matched historical patients who received high dose corticosteroids followed by a standard taper