Department of Respiratory Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
Bone Marrow Transplant. 2013 May;48(5):703-7. doi: 10.1038/bmt.2012.197. Epub 2012 Oct 15.
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.
慢性移植物抗宿主病（cGVHD）相关的闭塞性细支气管炎综合征（BOS）是异基因造血干细胞移植（allo-SCT）后的严重并发症，肺移植（LTx）可能是最终的治疗选择。为了评估这种治疗方法，记录了在瑞典、挪威、丹麦和芬兰进行的所有异基因造血干细胞移植后接受 LTx 的患者的数据，并与 Scandiatransplant 登记处的生存数据进行了比较。总共在 13 名患者中进行了 allo-SCT 后 LTx。 allo-SCT 是因为 AML（n=6）、CML（n=3）、ALL（n=2）、免疫缺陷（n=1）和再生障碍性贫血（n=1）而进行的。所有患者均出现临床 cGVHD，从 allo-SCT 到 LTx 的中位间隔为 8.2（0.7-16）年。LTx 时的中位年龄为 34（16-55）岁，中位术后观察时间为 4.2（0.1-15）年。2 例患者分别在术后 2 个月和 14 个月因败血症和复发性白血病死亡。4 例患者发生 BOS，其中 1 例再次接受移植。LTx 的生存率与匹配的 LTx 对照组无显著差异，LTx 后 1 年生存率为 90%，5 年生存率为 75%，对照组分别为 85%和 68%。因此，我们建议对于因 allo-SCT 后 cGVHD 而发生 BOS 的患者，可以考虑进行 LTx。
