Efficacy of Fluticasone Propionate Associated With Salmeterol Using Inhalation Chamber Versus Placebo to Improve the Respiratory Function in Children Over Six Years of Age Who Underwent Allogeneic Hematopoietic Stem Cell Transplantation With a Decline of FEV1 10% From Pre Transplantation

Description

It's a prospective randomized double blind, multicentre, parallel-group in a 1:1 ratio, controlled and superiority trial.

The primary objective is to assess the effect of a Fluticasone Propionate associated with Salmeterol using inhalation chamber compared to placebo on respiratory function at 6 months in children over six years of age who underwent allogeneic hematopoietic stem cell transplantation with a decline of FEV1 10% from pre transplantation.

The primary criterion will be the difference in the FEV1% predicted value from inclusion to 6 months following the initiation of treatment.

To assess the effect of a Fluticasone Propionate associated with Salmeterol using inhalation chamber compared to placebo in children over six years old underwent allogeneic hematopoietic stem cell transplantation with a decline of FEV1 10% from pre transplantation baseline to 6 months following the initiation of treatment, and 6 months after the end of treatment, on pulmonary function, respiratory symptoms, Bronchiolitis Obliterative Syndrome (BOS) rate, oral steroid exposure and occurrence of infections;

To assess potential confounding factors associated to the 6-months inhaled treatment efficacy from baseline to 12 months, especially:

• GVHD (Graft Versus Host Disease) occurrence, severity and treatment (steroid dose exposure, calcineurins inhibitors dose, second line of GVHD treatment); To assess the safety and tolerability of the treatment at baseline, M1, M3 and M6 following the initiation of treatment

All endpoints were collected at baseline, randomization, 1, 3, 6 months during the treatment period, and then 3, 6 months after the end of the treatment.

1. Endpoints relative to respiratory symptoms :
   • dyspnea will be evaluate at the NYHA (New York Heart Association) scoring;
   • step test (patient climb up and down step during three minutes at the frequency of 30/mn) : Respiratory rate, dyspnea Heart rate, SaO2 (oxygen saturation) during the exercise.
2. Endpoints relative to pulmonary function :
   • FEV1 (Forced expiratory volume) VC (Vital Capacity) , TLC (Total Lung capacity) , RV (Residual volume), FRC (Functional Residual Capacity), sRaw (specific airway resistance) DLCO (diffusing capacity of the lungs) using a similar method of measurement for static lung volumes (plethysmography)
   • Number of patients presented with BOS defined as the absence of infection, and FEV1 < 75% predicted, and the FEV1/ FVC < 0.7, and the RV >120% or air trapping or bronchiectasis or small airways thickening on computed tomography
3. Endpoints relative to GVHD :
   • Acute and Chronic GVHD manifestations defined on NIH consensus with scoring;
   • First line of treatment: cumulative dose of corticosteroid systemic exposure and cumulative dose of calcineurins inhibitors.
   • Second line of GVHD treatment exposure will be assessed using the other type of treatment.
4. Endpoints relative to respiratory infections :
   • Number of adverse events.
5. Endpoints relative to safety and tolerance:
   • Adverse events during the study period such as treatment tolerance, thrush, death.

The investigators will study patients over six years of age who underwent allogeneic hematopoietic stem cell transplantation with a decline of FEV1 10% from pre transplantation.

The choice of this range of age is motivated by the fact that PFTs (Pulmonary Function Test) requires a degree of cooperation that is age dependent, only children who are 6 years of age or older are able to realize reproducible PFTs.

For children between 6 to 11 years (< 12 years): 50 g inhaled fluticasone propionate and 25 g salmeterol (SERETIDE 50/25) :two puffs twice a day from randomisation during 6 months using inhalation chamber

• For children between 12 to 17 years (> or = 12 years) : 125 g inhaled fluticasone propionate and 25 g salmeterol (SERETIDE 125/25): two puffs twice a day from randomisation during 6 months using inhalation chamber For children between 6 to 11 years (< 12 years): placebo of SERETIDE 50/25 :two puffs twice a day from randomisation during 6 months using inhalation chamber For children between 12 to 17 years (> or = 12 years) : placebo of SERETIDE 125/25: two puffs twice a day from randomisation during 6 months using inhalation chamber

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