Pleurodesis: A Novel Treatment Option for Refractory Chronic Graft vs Host Disease-Associated Serositis

SESSION TITLE: Pleural Effusions SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Chronic graft vs host disease (cGvHD)-associated serositis is a rare manifestation after hematopoietic stem cell transplantation (SCT). Little is known about this condition; previous case reports and series describe it as a chronic recurring condition. At present, there is no standard treatment for cGvHD-associated serositis. However, complete drainage of effusions with augmentation of immunosuppression has been shown to be effective in some patients. We describe 3 patients who underwent pleurodesis for refractory cGvHD-associated serositis that was unresponsive to thoracentesis and augmented immunosuppression. CASE PRESENTATION: Patient 1: A 64-year-old man underwent allogenic SCT for acute myelogenous leukemia complicated by cGvHD of the skin, gut and eyes. He developed bilateral large pleural effusions and a small pericardial effusion 425 days after transplant and had 3 left sided thoracenteses with steroid burst over the ensuing 4 months. Due to recurrence of the effusion on high dose steroids and sirolimus, he underwent left sided talc pleurodesis. In the 14 months since pleurodesis, he has been asymptomatic without evidence of increasing pleural or pericardial effusion. Patient 2: A 58-year-old woman underwent allogeneic SCT for multiple myeloma, complicated by cGvHD of skin and gut. She presented with bilateral small pleural effusions 1664 days after transplant. These remained asymptomatic for 1.5 years but then rapidly increased in size. She required bilateral therapeutic thoracentesis in addition to a steroid burst and initiation of sirolimus. The effusions, however, rapidly re-accumulated and accordingly she underwent bilateral doxycycline pleurodesis. Unfortunately, she had a poor response to pleurodesis necessitating placement of bilateral chronic pleural drainage tubes. She has been drained every other day for the past 4 months since pleurodesis. Patient 3: A 62-year-old man who underwent allogenic SCT for chronic myelogenous leukemia, with cGvHD of skin and gut, developed left sided moderate pleural effusion 987 days after transplant. He underwent thoracentesis with augmentation of immunosuppression and was asymptomatic for 2 years. He presented again with increasing left effusion and underwent repeat thoracentesis. However, due to poor response to immunosuppressives, he underwent talc pleurodesis. In the 4 years since pleurodesis, there has been no recurrence of effusions. DISCUSSION: We present 3 patients who underwent pleurodesis for recurrent poorly controlled cGvHD associated serositis. Pleurodesis was effective in 2 out of 3 of our patients. Based on our experience, pleurodesis should be considered as a treatment option for refractory cGvHD associated serositis. CONCLUSIONS: Further investigation is necessary to determine the optimal timing of pleurodesis and need for maintenance immunosuppressives in this patient group. Reference #1: Leonard J, Newell L, Meyers G et al. Chronic GvHD-associated serositis and pericarditis. Bone Marrow Transplantation. 2015;50(8):1098-1104 DISCLOSURE: The following authors have nothing to disclose: Priyanka Ballal, Patrick Arndt, Scott Twaddell No Product/Research Disclosure Information