Outcomes of Lung Transplantation After Allogeneic Hematopoietic Stem Cell Transplantation.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, Volume 20, Issue 8, p.1169-75 (2014)

Keywords:

2014, Center-Authored Paper, Clinical Research Division, May 2014, Research Trials Office Core Facility - Biostatistics Service, Shared Resources

Abstract:

Other than lung transplantation (LT), no specific therapies exist for end-stage lung disease resulting from HCT-related complications such as bronchiolitis obliterans syndrome (BOS). We describe the indications and outcomes in patients who had LT after HCT for hematologic disease from a retrospective case series at our institution and a review of the medical literature. A total of 70 cases of LT after HCT were identified, including 9 allogeneic HCT recipients from our institution who received LT between 1990 and 2010. For our cohort, the median age was 16 years (range 10-35) at the time of HCT and 34 years (range 17-44) at the time of LT, with a median interval between HCT and LT of 10 years (range 2.9-27). Indications for LT included pulmonary fibrosis (n=4), BOS (n=3), interstitial pneumonitis related to graft-versus-host-disease (GVHD)(n=1), and primary pulmonary hypertension (n=1). Median survival was 49 months (range 2 weeks to 87 months) and one patient remains alive >3 years after LT. Survival at one and five years after LT was 89% and 37%, respectively. In the medical literature from 1992 to July 2013, there are 20 manuscripts describing 61 cases of LT after HCT from various centers in the United States, Europe, and Asia. Forty-three percent (26/61) of cases were <18 years of age at the time of LT. BOS and GVHD of the lung were cited as the indication for LT in the majority of cases (49/61, 80%), followed by pulmonary fibrosis and interstitial lung disease (12/61, 20%). In publications reporting 3 or more cases with a follow-up interval ranging from immediate post-op to 16 years, the survival rate was 71% (39/55). Most deaths were attributed to long-term complications of the lung allograft, including infections and BOS. Two deaths were related to recurrent or relapsed hematologic malignancy. LT can prolong survival in some patients who suffer from end-stage pulmonary complications after HCT. Patient factors that likely improve the chances of a good long-term outcome include young age, at least 2 years from HCT free of relapse from the original hematologic malignancy, and lack of other end-organ dysfunction or manifestations of chronic GVHD that require treatment with immunosuppressive agents.