Intravenous pulse cyclophosphamide in the treatment of interstitial lung disease due to collagen vascular diseases
Identifieur interne : 002848 ( Main/Exploration ); précédent : 002847; suivant : 002849Intravenous pulse cyclophosphamide in the treatment of interstitial lung disease due to collagen vascular diseases
Auteurs : A. Schnabel [Allemagne] ; M. Reuter [Allemagne] ; W. L. Gross [Allemagne]Source :
- Arthritis and rheumatism [ 0004-3591 ] ; 1998.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Calendrier d'administration des médicaments, Cyclophosphamide (administration et posologie), Femelle, Granulocytes neutrophiles (cytologie), Humains, Immunosuppresseurs (administration et posologie), Injections veineuses, Liquide de lavage bronchoalvéolaire (immunologie), Lymphocytes (cytologie), Maladies du collagène (), Maladies du collagène (imagerie diagnostique), Maladies vasculaires (), Maladies vasculaires (imagerie diagnostique), Mâle, Pneumopathies interstitielles (), Pneumopathies interstitielles (imagerie diagnostique), Pneumopathies interstitielles (traitement médicamenteux), Résultat thérapeutique, Sujet âgé, Tests de la fonction respiratoire, Tomodensitométrie, Études prospectives.
- MESH :
- administration et posologie : Cyclophosphamide, Immunosuppresseurs.
- cytologie : Granulocytes neutrophiles, Lymphocytes.
- imagerie diagnostique : Maladies du collagène, Maladies vasculaires, Pneumopathies interstitielles.
- immunologie : Liquide de lavage bronchoalvéolaire.
- traitement médicamenteux : Pneumopathies interstitielles.
- Pascal (Inist)
- Adulte, Adulte d'âge moyen, Calendrier d'administration des médicaments, Femelle, Humains, Injections veineuses, Lupus érythémateux, Disséminé, Maladies du collagène, Maladies vasculaires, Mâle, Pneumopathies interstitielles, Résultat thérapeutique, Sclérodermie, Polymyosite, Sjögren syndrome, Pneumopathie interstitielle, Association morbide, Sujet âgé, Tests de la fonction respiratoire, Tomodensitométrie, Traitement, Cyclophosphamide, Modulation impulsion, Voie intraveineuse, Efficacité traitement, Homme, Moutarde à l'azote, Oxazaphosphinane dérivé, Études prospectives.
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
- Adult, Aged, Bronchoalveolar Lavage Fluid (immunology), Collagen Diseases (complications), Collagen Diseases (diagnostic imaging), Concomitant disease, Cyclophosphamide, Cyclophosphamide (administration & dosage), Disseminated, Drug Administration Schedule, Female, Human, Humans, Immunosuppressive Agents (administration & dosage), Injections, Intravenous, Interstitial pneumonitis, Intravenous administration, Lung Diseases, Interstitial (complications), Lung Diseases, Interstitial (diagnostic imaging), Lung Diseases, Interstitial (drug therapy), Lupus erythematosus, Lymphocytes (cytology), Male, Middle Aged, Neutrophils (cytology), Nitrogen mustard, Oxazaphosphinane derivatives, Polymyositis, Prospective Studies, Pulse modulation, Respiratory Function Tests, Scleroderma, Sjögren syndrome, Tomography, X-Ray Computed, Treatment, Treatment Outcome, Treatment efficiency, Vascular Diseases (complications), Vascular Diseases (diagnostic imaging).
- MESH :
- chemical , administration & dosage : Cyclophosphamide, Immunosuppressive Agents.
- complications : Collagen Diseases, Lung Diseases, Interstitial, Vascular Diseases.
- cytology : Lymphocytes, Neutrophils.
- diagnostic imaging : Collagen Diseases, Lung Diseases, Interstitial, Vascular Diseases.
- drug therapy : Lung Diseases, Interstitial.
- immunology : Bronchoalveolar Lavage Fluid.
- Adult, Aged, Drug Administration Schedule, Female, Humans, Injections, Intravenous, Male, Middle Aged, Prospective Studies, Respiratory Function Tests, Tomography, X-Ray Computed, Treatment Outcome.
Abstract
Objective. Substantial toxicity limits the use of daily oral cyclophosphamide (CYC) for the treatment of interstitial lung disease (ILD) due to collagen vascular diseases. We examined whether intravenous (IV) pulse CYC can be substituted for daily oral therapy. Methods. Six patients with rapidly progressive ILD due to polymyositis, systemic sclerosis, systemic lupus erythematosus, or primary Sjögren's syndrome received 6-9 cycles of IV pulse CYC (0.5 gm/m2 of body surface area), together with an initial course of 50 mg of prednisolone, which was tapered to a maintenance dosage of 5-7.5 mg/day, and their response was measured clinically, by high-resolution computed tomography (HRCT) and by assessment of the bronchoalveolar lavage (BAL) cell profile. Results. All patients showed significant improvement in exercise tolerance and lung function. Elevated BAL neutrophils dropped substantially, whereas the response of BAL lymphocytes was inconsistent. Low-attenuation opacities in the HRCT regressed in 4 patients and remained unchanged in 2, but reticular infiltrates remained largely unaffected. Remission was maintained with hydroxychloroquine, azathioprine, or cyclosporin A. Conclusion. IV pulse CYC proved to be an effective and well-tolerated treatment in these patients. Since it appears to target mainly the inflammatory component of the disease, it should be reserved for progressive ILD featuring indices of high inflammatory activity.
Affiliations:
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Reuter</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Rheumaklinik Bad Bramstedt</s1><s2>Bad Bramstedt</s2><s3>DEU</s3><sZ>2 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Bad Bramstedt</wicri:noRegion><wicri:noRegion>Rheumaklinik Bad Bramstedt</wicri:noRegion><wicri:noRegion>Rheumaklinik Bad Bramstedt</wicri:noRegion></affiliation></author><author><name sortKey="Gross, W L" sort="Gross, W L" uniqKey="Gross W" first="W. L." last="Gross">W. L. 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Schnabel</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Universität Lübeck</s1><s2>Lübeck</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Lübeck</wicri:noRegion><wicri:noRegion>Universität Lübeck</wicri:noRegion><wicri:noRegion>Universität Lübeck</wicri:noRegion></affiliation></author><author><name sortKey="Reuter, M" sort="Reuter, M" uniqKey="Reuter M" first="M." last="Reuter">M. Reuter</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Rheumaklinik Bad Bramstedt</s1><s2>Bad Bramstedt</s2><s3>DEU</s3><sZ>2 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Bad Bramstedt</wicri:noRegion><wicri:noRegion>Rheumaklinik Bad Bramstedt</wicri:noRegion><wicri:noRegion>Rheumaklinik Bad Bramstedt</wicri:noRegion></affiliation></author><author><name sortKey="Gross, W L" sort="Gross, W L" uniqKey="Gross W" first="W. L." last="Gross">W. L. Gross</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Universität Lübeck</s1><s2>Lübeck</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Lübeck</wicri:noRegion><wicri:noRegion>Universität Lübeck</wicri:noRegion><wicri:noRegion>Universität Lübeck</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Arthritis and rheumatism</title><title level="j" type="abbreviated">Arthritis rheum.</title><idno type="ISSN">0004-3591</idno><imprint><date when="1998">1998</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Arthritis and rheumatism</title><title level="j" type="abbreviated">Arthritis rheum.</title><idno type="ISSN">0004-3591</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Bronchoalveolar Lavage Fluid (immunology)</term><term>Collagen Diseases (complications)</term><term>Collagen Diseases (diagnostic imaging)</term><term>Concomitant disease</term><term>Cyclophosphamide</term><term>Cyclophosphamide (administration & dosage)</term><term>Disseminated</term><term>Drug Administration Schedule</term><term>Female</term><term>Human</term><term>Humans</term><term>Immunosuppressive Agents (administration & dosage)</term><term>Injections, Intravenous</term><term>Interstitial pneumonitis</term><term>Intravenous administration</term><term>Lung Diseases, Interstitial (complications)</term><term>Lung Diseases, Interstitial (diagnostic imaging)</term><term>Lung Diseases, Interstitial (drug therapy)</term><term>Lupus erythematosus</term><term>Lymphocytes (cytology)</term><term>Male</term><term>Middle Aged</term><term>Neutrophils (cytology)</term><term>Nitrogen mustard</term><term>Oxazaphosphinane derivatives</term><term>Polymyositis</term><term>Prospective Studies</term><term>Pulse modulation</term><term>Respiratory Function Tests</term><term>Scleroderma</term><term>Sjögren syndrome</term><term>Tomography, X-Ray Computed</term><term>Treatment</term><term>Treatment Outcome</term><term>Treatment efficiency</term><term>Vascular Diseases (complications)</term><term>Vascular Diseases (diagnostic imaging)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Calendrier d'administration des médicaments</term><term>Cyclophosphamide (administration et posologie)</term><term>Femelle</term><term>Granulocytes neutrophiles (cytologie)</term><term>Humains</term><term>Immunosuppresseurs (administration et posologie)</term><term>Injections veineuses</term><term>Liquide de lavage bronchoalvéolaire (immunologie)</term><term>Lymphocytes (cytologie)</term><term>Maladies du collagène ()</term><term>Maladies du collagène (imagerie diagnostique)</term><term>Maladies vasculaires ()</term><term>Maladies vasculaires (imagerie diagnostique)</term><term>Mâle</term><term>Pneumopathies interstitielles ()</term><term>Pneumopathies interstitielles (imagerie diagnostique)</term><term>Pneumopathies interstitielles (traitement médicamenteux)</term><term>Résultat thérapeutique</term><term>Sujet âgé</term><term>Tests de la fonction respiratoire</term><term>Tomodensitométrie</term><term>Études prospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Cyclophosphamide</term><term>Immunosuppressive Agents</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Cyclophosphamide</term><term>Immunosuppresseurs</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Collagen Diseases</term><term>Lung Diseases, Interstitial</term><term>Vascular Diseases</term></keywords><keywords scheme="MESH" qualifier="cytologie" xml:lang="fr"><term>Granulocytes neutrophiles</term><term>Lymphocytes</term></keywords><keywords scheme="MESH" qualifier="cytology" xml:lang="en"><term>Lymphocytes</term><term>Neutrophils</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Collagen Diseases</term><term>Lung Diseases, Interstitial</term><term>Vascular Diseases</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Lung Diseases, Interstitial</term></keywords><keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Maladies du collagène</term><term>Maladies vasculaires</term><term>Pneumopathies interstitielles</term></keywords><keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Liquide de lavage bronchoalvéolaire</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Bronchoalveolar Lavage Fluid</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Pneumopathies interstitielles</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Drug Administration Schedule</term><term>Female</term><term>Humans</term><term>Injections, Intravenous</term><term>Male</term><term>Middle Aged</term><term>Prospective Studies</term><term>Respiratory Function Tests</term><term>Tomography, X-Ray Computed</term><term>Treatment Outcome</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Calendrier d'administration des médicaments</term><term>Femelle</term><term>Humains</term><term>Injections veineuses</term><term>Lupus érythémateux</term><term>Disséminé</term><term>Maladies du collagène</term><term>Maladies vasculaires</term><term>Mâle</term><term>Pneumopathies interstitielles</term><term>Résultat thérapeutique</term><term>Sclérodermie</term><term>Polymyosite</term><term>Sjögren syndrome</term><term>Pneumopathie interstitielle</term><term>Association morbide</term><term>Sujet âgé</term><term>Tests de la fonction respiratoire</term><term>Tomodensitométrie</term><term>Traitement</term><term>Cyclophosphamide</term><term>Modulation impulsion</term><term>Voie intraveineuse</term><term>Efficacité traitement</term><term>Homme</term><term>Moutarde à l'azote</term><term>Oxazaphosphinane dérivé</term><term>Études prospectives</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective. Substantial toxicity limits the use of daily oral cyclophosphamide (CYC) for the treatment of interstitial lung disease (ILD) due to collagen vascular diseases. We examined whether intravenous (IV) pulse CYC can be substituted for daily oral therapy. Methods. Six patients with rapidly progressive ILD due to polymyositis, systemic sclerosis, systemic lupus erythematosus, or primary Sjögren's syndrome received 6-9 cycles of IV pulse CYC (0.5 gm/m<sup>2</sup> of body surface area), together with an initial course of 50 mg of prednisolone, which was tapered to a maintenance dosage of 5-7.5 mg/day, and their response was measured clinically, by high-resolution computed tomography (HRCT) and by assessment of the bronchoalveolar lavage (BAL) cell profile. Results. All patients showed significant improvement in exercise tolerance and lung function. Elevated BAL neutrophils dropped substantially, whereas the response of BAL lymphocytes was inconsistent. Low-attenuation opacities in the HRCT regressed in 4 patients and remained unchanged in 2, but reticular infiltrates remained largely unaffected. Remission was maintained with hydroxychloroquine, azathioprine, or cyclosporin A. Conclusion. IV pulse CYC proved to be an effective and well-tolerated treatment in these patients. Since it appears to target mainly the inflammatory component of the disease, it should be reserved for progressive ILD featuring indices of high inflammatory activity.</div></front></TEI><affiliations><list><country><li>Allemagne</li></country></list><tree><country name="Allemagne"><noRegion><name sortKey="Schnabel, A" sort="Schnabel, A" uniqKey="Schnabel A" first="A." last="Schnabel">A. Schnabel</name></noRegion><name sortKey="Gross, W L" sort="Gross, W L" uniqKey="Gross W" first="W. L." last="Gross">W. L. Gross</name><name sortKey="Reuter, M" sort="Reuter, M" uniqKey="Reuter M" first="M." last="Reuter">M. 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