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Long-term clinical course and outcomes in patients with lymphangioleiomyomatosis

Authors
  • Yoon, Hee-Young
  • Kim, Ho Jeong
  • Song, Jin Woo
Type
Published Article
Journal
Respiratory Research
Publisher
BioMed Central
Publication Date
Jun 18, 2022
Volume
23
Identifiers
DOI: 10.1186/s12931-022-02079-6
PMID: 35717210
PMCID: PMC9206248
Source
PubMed Central
Keywords
Disciplines
  • Research
License
Unknown

Abstract

Background Lymphangioleiomyomatosis (LAM) is a rare multisystemic disorder with various clinical manifestations. Despite the recognition of several prognostic factors, the long-term clinical course and prognosis of patients with LAM in the era of sirolimus therapy are not established. Methods The clinical data of 104 patients with LAM were retrospectively analyzed. Death or lung transplantation was defined as the primary outcome. Disease progression (DP) was defined as a 10% absolute decline in forced expiratory volume in one second (FEV1). Results The mean age of all patients was 40.3 years. Over a median follow-up period of 7.1 years, of all patients, 6.7% died and 1.9% underwent lung transplantation, while of 92 patients with serial lung function data, 35.9% experienced DP. The 5-year and 10-year overall survival rates were 93.0% and 90.9%, respectively. The multivariable Cox analysis revealed that older age (hazard ratio [HR]: 1.136, P = 0.025), lower FEV1 (HR: 0.956, P = 0.026) or diffusing capacity for carbon monoxide (HR: 0.914, P = 0.003), and shorter distance during the 6-min walk test (HR: 0.993, P = 0.020) were independent prognostic factors for mortality. A propensity score-matched comparative analysis performed between patients who received sirolimus therapy and those who did not, found no differences in survival, DP, complications, and lung function decline rate. Conclusions Over a follow-up period of approximately 7 years, one-tenth of all patients experienced death, while one-third experienced DP. Older age, lower lung function, and reduced exercise capacity were associated with a poor prognosis in patients with LAM. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02079-6.

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