Inhaled GM-CSF for Pulmonary Alveolar Proteinosis

To the Editor: In reporting the results of the Pulmonary Alveolar Proteinosis GM-CSF Inhalation Efficacy (PAGE) trial, Tazawa and coworkers (Sept. 5 issue)¹ conclude that there was “a modest salutary effect” on a laboratory outcome but no clinical benefits of inhaled recombinant granulocyte–macrophage colony-stimulating factor (GM-CSF) in patients with autoimmune pulmonary alveolar proteinosis. For 11 years, we have treated a cohort of 28 patients with this condition with only inhaled recombinant GM-CSF, since we do not have access to reliable whole-lung lavage. In our experience, inhaled recombinant GM-CSF must be used for 1 year or longer in order to achieve . . .