Lung transplantation for bronchiolitis obliterans syndrome after allo-SCT.
Chronic GVHD (cGVHD) associated bronchiolitis obliterans syndrome (BOS) is a serious complication after allo-SCT, and lung transplantation (LTx) may be the ultimate treatment option. To evaluate this treatment, data on all patients with LTx after allo-SCT ever performed in Sweden, Norway, Denmark and Finland were recorded and compared with survival data from the Scandiatransplant registry. In total, LTx after allo-SCT had been performed in 13 patients. Allo-SCT was done because of AML (n=6), CML (n=3), ALL (n=2), immunodeficiency (n=1) and aplastic anemia (n=1). All developed clinical cGVHD, with median interval from allo-SCT to LTx of 8.2 (0.7-16) years. Median age at LTx was 34 (16-55) years, and the median postoperative observation time was 4.2 (0.1-15) years. Two patients died, one due to septicemia, the other of relapsing leukemia, after 2 and 14 months, respectively. Four developed BOS, one of these was retransplanted. The survival did not significantly differ from the survival in matched LTx controls, being 90% 1 year and 75% 5 years after LTx compared with 85% and 68% in the controls. We therefore suggest that LTx may be considered in carefully selected patients with BOS due to cGVHD after allo-SCT.
Department of Respiratory Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. a.m.holm@medisin.uio.no
A M
AM
Holm
G C
GC
Riise
L
L
Hansson
L
L
Brinch
O
O
Bjørtuft
M
M
Iversen
S
S
Simonsen
Y
Y
Fløisand
D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D019337:Hematologic Neoplasms / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D016019:Survival Analysis; D055815:Young Adult