1. Bronchoalveolar Lavage and Response to Cyclophosphamide in Scleroderma Interstitial Lung Disease
- Author
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Virginia D. Steen, Naomi F. Rothfield, Ed Parsley, Carla Maynetto, Sarinnapha Vasunilashorn, Jeffrey Golden, Edrick Forbes, Xiaohong Yan, Mildred Sterz, Jonathan G. Goldin, Donald P. Tashkin, David J. Riley, Marcie Bolster, Arthur C. Theodore, Deborah A. McCloskey, Irene Da Costa, Anise Carey, Fran Ingenito, Macha Aberles, Barbara White, Michael F. Bonner, Joanie Chung, Robert D. Suh, Sean Wheaton, Ken Bulpitt, James R. Seibold, Daniel Furst, José L. Granda, Marcy B. Bolster, Philip J. Clements, Adriana Ortiz, Mark Bohlman, June Arnold, Kimberley Tobin, Elena Breen, Robert E. Elashoff, Colleen Sanders, Sherrie Viasco, David Lapota, Ronika Alexander, Judy Ho, Maureen Mayes, Kamal K. Mubarak, Steve Schabel, Richard M. Silver, Robert W. Simms, Michael Roth, Charlie Strange, Amanda Mondt, J H Korn, Wen Ling Joanie Chung, Vivien Hsu, Laura K. Hummers, Richard I. Silver, Mark Metersky, Fred M. Wigley, Katie Caldwell, Albert J. Polito, Tan Filemon, Sandra A. A. Oldham, Robert Elashoff, John Varga, John A. Davis, Shiva Arami, Edwin Smith, Andrew Wilbur, Dinesh Khanna, Mitchell A. Olman, Melynn Nuite, Tina Parkhill, Patricia Cole-Saffold, Peter Clarke, Robert A. Wise, Gwen Leatherman, Christine Antolos, Joseph Silva, Barri J. Fessler, Edwin A. Smith, Louis W. Heck, Marilyn Perry, Paul Wolters, Julianne E. Wilson, Lovlette Woolcock, Jerry A. Molitor, Daniel E. Furst, Richard Cobb, Steven Kirkland, Dean Schraufnagel, Judith K. Amorosa, Zora Injic, Samantha Jordan, Richard Hinke, Michael D. Roth, Charles A. Read, Richard Webb, Kari Connolly, Marie Daniel, Cirrelda Cooper, and Steven Springmeyer
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,Vital capacity ,Neutrophils ,Vital Capacity ,Population ,Critical Care and Intensive Care Medicine ,Gastroenterology ,Scleroderma ,Leukocyte Count ,Double-Blind Method ,Forced Expiratory Volume ,Internal medicine ,Intensive care ,medicine ,Humans ,education ,Cyclophosphamide ,Aged ,education.field_of_study ,Scleroderma, Systemic ,Lung ,medicine.diagnostic_test ,business.industry ,E. Interstitial Lung Disease ,Respiratory disease ,Interstitial lung disease ,respiratory system ,Middle Aged ,medicine.disease ,respiratory tract diseases ,Eosinophils ,Bronchoalveolar lavage ,medicine.anatomical_structure ,Female ,Lung Diseases, Interstitial ,business ,Bronchoalveolar Lavage Fluid ,Tomography, Spiral Computed ,Immunosuppressive Agents - Abstract
The presence of inflammatory cells on bronchoalveolar lavage is often used to predict disease activity and the need for therapy in systemic sclerosis-associated interstitial lung disease.To evaluate whether lavage cellularity identifies distinct subsets of disease and/or predicts cyclophosphamide responsiveness.Patients underwent baseline lavage and/or high-resolution computed tomography as part of a randomized placebo-controlled trial of cyclophosphamide versus placebo (Scleroderma Lung Study) to determine the effect of therapy on forced vital capacity. Patients with 3% or greater polymorphonuclear and/or 2% or greater eosinophilic leukocytes on lavage and/or ground-glass opacification on computed tomography were eligible for enrollment.Lavage was performed in 201 individuals, including 141 of the 158 randomized patients. Abnormal cellularity was present in 101 of these cases (71.6%) and defined a population with a higher percentage of men (P = 0.04), more severe lung function, including a worse forced vital capacity (P = 0.003), worse total lung capacity (P = 0.005) and diffusing capacity of the lung for carbon monoxide (P = 0.004), more extensive ground-glass opacity (P = 0.005), and more extensive fibrosis in the right middle lobe (P = 0.005). Despite these relationships, the presence or absence of an abnormal cell differential was not an independent predictor of disease progression or response to cyclophosphamide at 1 year (P = not significant).The presence of an abnormal lavage in the Scleroderma Lung Study defined patients with more advanced interstitial lung disease but added no additional value to physiologic and computed tomography findings as a predictor of progression or treatment response. Clinical trial registered with www.clinicaltrials.gov (NCT 000004563).
- Published
- 2008
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