BACKGROUND: Bronchiolitis obliterans (BO) is a detrimental late pulmonary complication after allogeneic hematopoietic stem cell transplantation (HCT) associated with chronic graft-versus-host disease (cGvHD). When systemic immunosuppressive treatment fails to improve, severe BO patients should be considered for lung transplantation (LuTX). We present seven patients undergoing LuTX for severe refractory BO after HCT. METHODS: Seven patients with hematologic malignancies developed severe cGvHD with lung involvement presenting as BO after allogeneic HCT. Evaluation for LuTX was initiated after failure of a median of 4 immunosuppressive regimens. RESULTS: Between 1996 and 2012, seven patients with severe refractory BO were evaluated for LuTX. The median time from HCT to diagnosis of chronic lung GvHD was 8.2 months (range, 3.7-16.6). At a median time of 18.1 months (range, 6-120) after diagnosis of BO, six patients received a bilateral sequential LuTX, and one patient received a single LuTX. Six postoperative courses were uneventful; the patient with single LuTX died from septic multiorgan failure. Three LuTX recipients had a mild acute rejection after one to three months after LuTX, and one patient experienced fatal chronic rejection and hemolytic uremic syndrome. At present, three (43%) LuTX recipients remain alive at a median observation time of 26 months (range, 1 month-16 years) after LuTX. The median overall survival from LuTX was 24 months (95% CI, 0.5-78); the median overall survival time after allogeneic HCT is 98 months (95% CI, 46-198). CONCLUSION: This case series illustrates that LuTX is a possible therapeutic option for selected patients with severe treatment-refractory BO.
BACKGROUND:Bronchiolitis obliterans (BO) is a detrimental late pulmonary complication after allogeneic hematopoietic stem cell transplantation (HCT) associated with chronic graft-versus-host disease (cGvHD). When systemic immunosuppressive treatment fails to improve, severe BO patients should be considered for lung transplantation (LuTX). We present seven patients undergoing LuTX for severe refractory BO after HCT. METHODS: Seven patients with hematologic malignancies developed severe cGvHD with lung involvement presenting as BO after allogeneic HCT. Evaluation for LuTX was initiated after failure of a median of 4 immunosuppressive regimens. RESULTS: Between 1996 and 2012, seven patients with severe refractory BO were evaluated for LuTX. The median time from HCT to diagnosis of chronic lung GvHD was 8.2 months (range, 3.7-16.6). At a median time of 18.1 months (range, 6-120) after diagnosis of BO, six patients received a bilateral sequential LuTX, and one patient received a single LuTX. Six postoperative courses were uneventful; the patient with single LuTX died from septic multiorgan failure. Three LuTX recipients had a mild acute rejection after one to three months after LuTX, and one patient experienced fatal chronic rejection and hemolytic uremic syndrome. At present, three (43%) LuTX recipients remain alive at a median observation time of 26 months (range, 1 month-16 years) after LuTX. The median overall survival from LuTX was 24 months (95% CI, 0.5-78); the median overall survival time after allogeneic HCT is 98 months (95% CI, 46-198). CONCLUSION: This case series illustrates that LuTX is a possible therapeutic option for selected patients with severe treatment-refractory BO.
Authors: Jason A Dubovsky; Ryan Flynn; Jing Du; Bonnie K Harrington; Yiming Zhong; Benjamin Kaffenberger; Carrie Yang; William H Towns; Amy Lehman; Amy J Johnson; Natarajan Muthusamy; Steven M Devine; Samantha Jaglowski; Jonathan S Serody; William J Murphy; David H Munn; Leo Luznik; Geoffrey R Hill; Henry K Wong; Kelli K P MacDonald; Ivan Maillard; John Koreth; Laurence Elias; Corey Cutler; Robert J Soiffer; Joseph H Antin; Jerome Ritz; Angela Panoskaltsis-Mortari; John C Byrd; Bruce R Blazar Journal: J Clin Invest Date: 2014-10-01 Impact factor: 14.808
Authors: Sameem Abedin; Gregory A Yanik; Thomas Braun; Attaphol Pawarode; John Magenau; Steven C Goldstein; John E Levine; Carrie L Kitko; Daniel R Couriel Journal: Biol Blood Marrow Transplant Date: 2015-02-14 Impact factor: 5.742
Authors: Matteo Di Nardo; Ali H Ahmad; Pietro Merli; Matthew S Zinter; Leslie E Lehman; Courtney M Rowan; Marie E Steiner; Sangeeta Hingorani; Joseph R Angelo; Hisham Abdel-Azim; Sajad J Khazal; Basirat Shoberu; Jennifer McArthur; Rajinder Bajwa; Saad Ghafoor; Samir H Shah; Hitesh Sandhu; Karen Moody; Brandon D Brown; Maria E Mireles; Diana Steppan; Taylor Olson; Lakshmi Raman; Brian Bridges; Christine N Duncan; Sung Won Choi; Rita Swinford; Matt Paden; James D Fortenberry; Giles Peek; Pierre Tissieres; Daniele De Luca; Franco Locatelli; Selim Corbacioglu; Martin Kneyber; Alessio Franceschini; Simon Nadel; Matthias Kumpf; Alessandra Loreti; Roelie Wösten-Van Asperen; Orsola Gawronski; Joe Brierley; Graeme MacLaren; Kris M Mahadeo Journal: Lancet Child Adolesc Health Date: 2021-12-09