Respiratory Medicine and Research最新文献

Background: Incidental lung cancer, in the field of lung transplantation (LTx), is more often related to malignancies diagnosed in explants or transplanted organs. Little is known about cancer diagnosed during the medical evaluation of potential LTx candidates. What are the clinical, and prognostic differences between lung cancers diagnosed before or after transplantation in LTx candidates?

Methods: We performed a retrospective, observational, single-center study to describe the characteristics of lung malignancies first discovered during the pre-transplant assessment and then identified in lung explants, over the same period.

Results: From 1630 consecutive patients referred to Paris-Bichat Lung Transplant Program from 2006 to 2022, 288 were deemed not suitable for transplantation. The reason was lung malignancy in 20 patients (15 non-small cell lung cancer (NSCLC) proved). The one-year survival rate was 55 %. Seven died from their respiratory insufficiency, and six died from lung cancer progression. Over the same period, 611 patients received LTx. NSCLC were identified in six explants (1 %). One-year survival was 66.7 % in these transplanted patients.

Conclusions: Lung cancer diagnosed during the medical evaluation of potential LTx candidates is rare. However, this represents a critical issue because it contraindicates LTx and leads to a non-optimal management of both lung cancer and of end-stage lung disease. We report an encouraging one-year survival rate in transplanted patients with a pathological lung malignancy diagnosis in lung explant, compared to their counterpart in whom lung cancer discovery contraindicated LTx. A multicenter observational study is mandatory in order to confirm such observation, as it might change current standard to deny LTx in patients with incidental localized NSCLC.

Introduction: Lung transplant (LT) recipients are at greater risk of complications from COVID-19. Treatment options are limited partly due to interactions with immunosuppressive agents. Convalescent plasma (CP) is a potential treatment option, but it has not been extensively studied in LT patients. We aimed to assess the efficacy and safety of CP use in France for COVID-19 infected LT patients.

Material and methods: We retrospectively recruited LT patients followed up in the 10 French LT centers, older than 18 years, infected with SARS-CoV-2 between the pandemic onset and July 1, 2023, and treated with high-titer CP.

Results: We collected the data from 27 patients who received CP for a COVID-19 infection in six out of the 10 French LT centers. The average delay between symptom onset and CP administration was 19.5 days, and 51.8 % of patients received four units. In patients treated within the first 9 days of infection, the survival rate was 100 % at one and three months vs. 75 % (p = 0.28) for late administration patients. Average loss of forced expiratory volume in 1 second at three months was 10.5 % in the early group vs. 3.3 % in the late group (p = 0.58). The average length of hospital stay was 18 and 24 days respectively (p = 0.07). Early use of CP was also more frequent in 2023.

Discussion: In this study highlighting the French experience for the use of CP in LT patients, we observed a limited, heterogenous but well-tolerated use of this therapy.

Introduction: Progressive interstitial lung diseases (ILDs) are rare but severe diseases, with high mortality and morbidity, with no effective pharmacological treatment allowing for long-term remission, and therefore no clear therapeutic recommendations. Several ILDs present inflammatory components (ILDic), which may justify the use of anti-inflammatory and immunosuppressive drugs, as first-step therapy. Except for systemic sclerosis (SSc)-ILD and sarcoidosis, the evidence in favor of this approach is very weak. The EvER-ILD2 study is the first one to prospectively evaluate the efficacy and safety of rituximab (RTX) versus placebo in a broad range of progressive ILD outside sarcoidosis and connective tissue diseases. A pharmacokinetic-pharmacodynamic analysis based on RTX serum concentrations will allow identification of potential factors associated with therapeutic response and/or adverse effects.

Methods: EvER-ILD2 study is a French multicentre, prospective, randomized, double blind, placebo-controlled, superiority trial. Patients with progressive ILDic will be randomized into 2 groups of treatment: one course of RTX (RTX group) and one course of placebo (Placebo group). The primary outcome is the change in Forced Vital Capacity (FVC, mL) from baseline to 6 months. Several clinical, biological, and quality of life secondary outcomes will be measured at 3 and 6 months. A sample size of 126 patients (63 patients per group) would allow to show a 100 mL difference between groups in the change of FVC from baseline to 6 months, based on a common standard deviation for FVC change of 200 mL with a power of 80% and a two-sided alpha of 5%.

Ethics and dissemination: The protocol was approved by the French Research Ethics Committee (CPP Ile de France VI) on September 27, 2022, and by the French competent authority on October 02, 2022. This article refers to protocol V1, dated September 2022. An independent data safety monitoring board will review safety data for the duration of the trial. Results will be disseminated via peer reviewed publication and presentation at international conferences.

Trial registration number: NCT05596786 (clinicaltrials.gov), EU-CT number 2022-500,375-31-00 (European Medicines agency).