Carson T. Moss

All Publications

• Bronchiectasis in bronchiolitis obliterans syndrome after hematopoietic cell transplantation. Transplantation and cellular therapy Epstein, D. J., Rodriguez-Ormaza, N., Sharifi, H., Lai, Y. K., Guo, H. H., Borges, C. H., Omar, S. H., Sahota, A., Dhillon, E. S., Musa, Z. M., Moss, C. T., Chatterjee, P., Hofmann, G. H., Johnston, L., Arai, S., Hsu, J. L. 2025

  Abstract

  Bronchiectasis-bronchial dilatation accompanied by impaired mucociliary clearance, chronic infection, and chronic inflammation-may contribute to poor outcomes in bronchiolitis obliterans syndrome (BOS) complicating hematopoietic cell transplantation, though its epidemiology and impact are poorly understood.We assessed factors associated with bronchiectasis in BOS. We also assessed relationships between bronchiectasis and survival, respiratory infections, and percent predicted forced expiratory volume in one second (FEV1%).This single-center retrospective cohort study included adults who underwent allogeneic hematopoietic cell transplantation from 2010-2023 who subsequently developed BOS. Bronchiectasis was defined based on validated radiographic and clinical criteria. We used multivariable logistic and linear regression, extended Cox regression models, negative binomial regression, and generalized estimating equation to determine relationships between pre-BOS events and subsequent bronchiectasis, and between bronchiectasis and death, infections, and FEV1%.Among the 87 patients included for analysis, 54% developed bronchiectasis over a median follow-up of 2.2 years (IQR, 1.0-5.8) after BOS diagnosis. Thirty-three patients (37.9%) died. None of the prespecified risk factors were associated with bronchiectasis. Bronchiectasis was associated with an increased risk of death (HR, 3.10; 95% CI, 1.40-6.48; P = .0048) and an increased incidence rate of respiratory infections (IRR, 1.93; 95% CI, 1.23-3.02; P = .0040), controlling for confounders. Among those with bronchiectasis, chronic infection with Pseudomonas aeruginosa occurred in 8 (17.0%) and nontuberculous mycobacteria in 11 (23.4%). FEV1% was lower and declined more rapidly in those with bronchiectasis.Bronchiectasis frequently accompanies BOS and is associated with 2 poorer outcomes, though its causes in this population are not known.

  View details for DOI 10.1016/j.jtct.2025.08.013

  View details for PubMedID 40818827

• Pirfenidone for the treatment of bronchiolitis obliterans syndrome related to chronic graft-versus-host disease. Blood advances Sharifi, H., Moss, C. T., Musa, Z., Bell, A., O'Donnell, C., Borges, C., Matthaiou, E. I., Johnston, L., Galban, C., Sheshadri, A., Yanik, G. A., Cheng, G. S., Hsu, J. L. 2025

  Abstract

  Bronchiolitis obliterans syndrome (BOS) is a severe form of chronic graft-versus-host disease (cGVHD) following allogeneic hematopoietic cell transplantation (HCT) with five-year survival of 40%. Currently, there is no curative therapy for BOS. Pre-clinical data suggest that pirfenidone, an anti-fibrotic drug, may benefit small airway fibrosis in HCT-associated BOS. A single-arm, open-label, 56-week phase 1 trial with 56-month extension evaluated pirfenidone's tolerability, safety, and efficacy in BOS patients. Efficacy was measured using pulmonary function tests (PFT), quantitative CT (qCT) scans, patient reported outcomes (PRO), cGVHD indices, and laboratory tests. Lung function trajectory was assessed by change in regression slopes before and during treatment. Baseline qCT metrics, including percentage normal lung, air trapping, volume change (Jacobian), and heterogeneity of volume change (Jacobian variance) were analyzed by participant response. Among 30 participants, 25 completed the 56-week trial, and 10 continued into the extension. Overall, 63% tolerated the recommended dose without safety concerns. There was significant improvement in the percent predicted forced expiratory volume in 1 second (P=0.00267) when analyzing all participants and improvement in individual PFT trend for 41.3% of participants. Quantitative CT analysis by lobe showed healthier lungs in the upper lobes of responders. Significant improvements were noted in liver function tests, PRO related to physical functioning and shortness of breath, and cGVHD skin indices. These findings indicate that pirfenidone is safe and tolerable in BOS patients post-HCT and may improve lung function and symptoms. Further trials are warranted to evaluate the efficacy of pirfenidone as a treatment for BOS after HCT. (NCT03315741).

  View details for DOI 10.1182/bloodadvances.2025016122

  View details for PubMedID 40554417

• Allergic Bronchopulmonary Aspergillosis (ABPA) in the Era of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Modulators. Journal of fungi (Basel, Switzerland) Chatterjee, P., Moss, C. T., Omar, S., Dhillon, E., Hernandez Borges, C. D., Tang, A. C., Stevens, D. A., Hsu, J. L. 2024; 10 (9)

  Abstract

  Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disease caused by Aspergillus fumigatus (Af), prevalent in persons with cystic fibrosis (CF) or asthma. In ABPA, Af proteases drive a T-helper cell-2 (Th2)-mediated allergic immune response leading to inflammation that contributes to permanent lung damage. Corticosteroids and antifungals are the mainstays of therapies for ABPA. However, their long-term use has negative sequelae. The treatment of patients with CF (pwCF) has been revolutionized by the efficacy of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy. Pharmacological improvement in CFTR function with highly effective elexacaftor/tezacaftor/ivacaftor (ETI) provides unprecedented improvements in lung function and other clinical outcomes of pwCF. The mechanism behind the improvement in patient outcomes is a continued topic of investigation as our understanding of the role of CFTR function evolves. As ETI therapy gains traction in CF management, understanding its potential impact on ABPA, especially on the allergic immune response pathways and Af infection becomes increasingly crucial for optimizing patient outcomes. This literature review aims to examine the extent of these findings and expand our understanding of the already published research focusing on the intersection between ABPA therapeutic approaches in CF and the rapid impact of the evolving CFTR modulator landscape. While our literature search yielded limited reports specifically focusing on the role of CFTR modulator therapy on CF-ABPA, findings from epidemiologic and retrospective studies suggest the potential for CFTR modulator therapies to positively influence pulmonary outcomes by addressing the underlying pathophysiology of CF-ABPA, especially by decreasing inflammatory response and Af colonization. Thus, this review highlights the promising scope of CFTR modulator therapy in decreasing the overall prevalence and incidence of CF-ABPA.

  View details for DOI 10.3390/jof10090656

  View details for PubMedID 39330416

• Home Hospital Outcomes for Acute Decompensated Heart Failure and Factors Associated With Escalation of Care. Circulation. Cardiovascular quality and outcomes Achanta, A., Wasfy, J. H., Moss, C. T., Cherukara, A., Ho, D., Boxer, R., Schmieding, M., Phadke, N. A., Thompson, R., Levine, D. M., Weiner, R. B. 2023: e010031

  Abstract

  BACKGROUND: Overall outcomes and the escalation rate for home hospital admissions for heart failure (HF) are not known. We report overall outcomes, predict escalation, and describe care provided after escalation among patients admitted to home hospital for HF.METHODS: Our retrospective analysis included all patients admitted for HF to 2 home hospital programs in Massachusetts between February 2020 and October 2022. Escalation of care was defined as transfer to an inpatient hospital setting (emergency department, inpatient medical unit) for at least 1 overnight stay. Unexpected mortality was defined as mortality excluding those who desired to pass away at home on admission or transitioned to hospice. We performed the least absolute shrinkage and selection operator logistic regression to predict escalation.RESULTS: We included 437 hospitalizations; patients had a median age of 80 (interquartile range, 69-89) years, 58.1% were women, and 64.8% were White. Of the cohort, 29.2% had reduced ejection fraction, 50.9% had chronic kidney disease, and 60.6% had atrial fibrillation. Median admission Get With The Guidelines HF score was 39 (interquartile range, 35-45; 1%-5% predicted inpatient mortality). Escalation occurred in 10.3% of hospitalizations. Thirty-day readmission occurred in 15.1%, 90-day readmission occurred in 33.8%, and 6-month mortality occurred in 11.5%. There was no unexpected mortality during home hospitalization. Patients who experienced escalation had significantly longer median length of stays (19 versus 7.5 days, P<0.001). The most common reason for escalation was progressive renal dysfunction (36.2%). A low mean arterial pressure at the time of admission to home hospital was the most significant predictor of escalation in the least absolute shrinkage and selection operator regression.CONCLUSIONS: About 1 in 10 home hospital patients with HF required escalation; none had unexpected mortality. Patients requiring escalation had longer length of stays. A low mean arterial pressure at the time of admission to home hospital was the most important predictor of escalation of care in the least absolute shrinkage and selection operator logistic regression model.

  View details for DOI 10.1161/CIRCOUTCOMES.123.010031

  View details for PubMedID 38054286

• Caregiver burden in a home hospital versus traditional hospital: A secondary analysis of a randomized controlled trial. Journal of the American Geriatrics Society Moss, C. T., Schnipper, J. L., Levine, D. M. 2023

  View details for DOI 10.1111/jgs.18603

  View details for PubMedID 37789659

• The Reply. The American journal of medicine Barkoudah, E., Moss, C., Connell, N. T. 2023; 136 (3): e56

  View details for DOI 10.1016/j.amjmed.2022.11.011

  View details for PubMedID 36796962

• Occam's Razor for Severe B12 Deficiency. The American journal of medicine Moss, C., Patil, D. T., Connell, N. T., Zon, R. L., Barkoudah, E. 2022; 135 (7): 844-847

  View details for DOI 10.1016/j.amjmed.2022.01.039

  View details for PubMedID 35139322