Living-donor lobar lung transplantation for broncho-bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation: does bronchiolitis obliterans recur in transplanted lungs?
We report a successful case of living-donor lobar lung transplantation (LDLLT) for therapy-resistant broncho-bronchiolitis obliterans (BBO) after allogeneic hematopoietic stem cell transplantation (HSCT). Bronchiolitis obliterans (BO) is one of the late-onset noninfectious pulmonary complications that occur after allogeneic HSCT and is usually resistant to immunosuppressive therapy. A 17-year-old girl with acute lymphoblastic leukemia (ALL) had undergone allogeneic bone marrow transplantation (BMT) from an HLA-matched sibling in 1997. Five years later, she relapsed with ALL and was treated with chemotherapy following stem cell rescue and donor lymphocyte infusion from the original BMT donor. Eight months later, BBO resistant to immunosuppressive therapies, including rituximab, developed in combination with chronic graft-versus-host disease (GVHD). In February 2004, the patient underwent LDLLT from 2 other family members who were mismatched at 3 HLA loci. The patient has been in good health for more than 30 months following LDLLT and shows no sign of BBO in the transplanted lungs, just as with other patients who have undergone lung transplantation for BO associated with chronic GVHD. LDLLT may therefore be considered a viable therapeutic option for the treatment of BO after allogeneic HSCT.
Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan. hokumura@med3.m.kanazawa-u.ac.jp
Hirokazu
H
Okumura
Shigeki
S
Ohtake
Yasuo
Y
Ontachi
Jun
J
Ozaki
Shigeru
S
Shimadoi
Yuko
Y
Waseda
Yukio
Y
Kondo
Hirohito
H
Yamazaki
Akiyoshi
A
Takami
Masahide
M
Yasui
Hiroshi
H
Date
Shinji
S
Nakao
D000293:Adolescent; D001989:Bronchiolitis Obliterans / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D006801:Humans; D019520:Living Donors; D016040:Lung Transplantation; D012008:Recurrence; D014184:Transplantation, Homologous
D015395:Histocompatibility Antigens Class I