Adult Recurrent Respirator Papillomatosis: A New Therapeutic Approach with Pegylated Interferon Alpha 2a (Peg-IFN alpha-2a) and GM-CSF

作者：Suter Montano Teresita^*; Montano Efraim; Martinez Carmen; Plascencia Teresita; Sepulveda Mayra T; Rodriguez Miguel

来源：Otolaryngology - Head and Neck Surgery, 2013, 148(2): 253-260.

DOI：10.1177/0194599812466226

• adult recurrent respiratory papillomatosis
• human papillomavirus
• Peg-IFN alpha-2a
• GM-CSF
• laryngeal papillomatosis

Objective. To determine a new therapeutic approach using granulocyte monocyte-colony-stimulating factor (GM-CSF) and pegylated interferon alpha 2a (Peg-IFN alpha-2a) as adjuvant therapy in patients with adult recurrent respiratory papillomatosis.
Study Design. Descriptive observational clinical trial.
Setting. Departments of Otolaryngology and Immunology.
Methods. Fourteen patients with adult recurrent respiratory papillomatosis were examined regarding medical history and number of operations before and after treatment. Voice disorder and glottal stop were evaluated using the Voice-Related Quality-of-Life instrument. Papilloma staging was determined using the Coltera/Derkay diagram. The patients received Peg-IFN alpha-2a at 180 mcg weekly for 6 months. In the third month, the patients began GM-CSF treatment at 400 mcg weekly for 2 months. The patients were observed for 12 months after treatment ended.
Results. Eleven patients met the study criteria; 3 patients had tracheotomies before treatment, and they were decannulated after treatment. Before treatment, the scale of voice quality ranged from 34 to 45 points (mean, 38.31). After treatment, the range was 12 to 35 points (mean, 21.09; P<.001). Prior to therapy, the glottal stop ranged from 50% to 90% (average, 62.27%). After therapy, the range decreased to 0% to 15% (mean, 4.63%; P<.001). The number of surgical interventions decreased. Two patients each had 1 surgical intervention after treatment began.
Conclusion. A new adjuvant treatment based on immunogenetic mechanisms against human laryngeal papilloma virus, with expectations of reducing disease aggressiveness and the number of operations, avoids the risks of surgery. Implication for Practice. Peg-IFN alpha-2a and GM-CSF is an adjuvant therapy for treating adult recurrent respiratory papillomatosis.

• 出版日期2013-2