Cheng Guang-Shing, Edelman Jeffrey D, Madtes David K, Martin Paul J, Flowers Mary E D
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington.
Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington; Veterans Association Puget Sound Health Care System, Seattle, Washington.
Biol Blood Marrow Transplant. 2014 Aug;20(8):1169-75. doi: 10.1016/j.bbmt.2014.04.008. Epub 2014 Apr 13.
Other than lung transplantation (LT), no specific therapies exist for end-stage lung disease resulting from hematopoietic stem cell transplantation (HCT)-related complications, such as bronchiolitis obliterans syndrome (BOS). We report the indications and outcomes in patients who underwent LT after HCT for hematologic disease from a retrospective case series at our institution and a review of the medical literature. We identified a total of 70 cases of LT after HCT, including 9 allogeneic HCT recipients from our institution who underwent LT between 1990 and 2010. In our cohort, the median age was 16 years (range, 10 to 35 years) at the time of HCT and 34 years (range, 17 to 44 years) at the time of LT, with a median interval between HCT and LT of 10 years (range, 2.9 to 27 years). 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 1 patient remains alive at more than 3 years after LT. Survival at 1 year and 5 years after LT was 89% and 37%, respectively. In the medical literature between 1992 and July 2013, we identified 20 articles describing 61 cases of LT after HCT from various centers in the United States, Europe, and Asia. Twenty-six of the 61 cases (43%) involved patients age <18 years at the time of LT. BOS and GVHD of the lung were cited as the indication for LT in the majority of cases (80%; n = 49), followed by pulmonary fibrosis and interstitial lung disease (20%; n = 12). In publications reporting 3 or more cases with a follow-up interval ranging from the immediate postoperative period to 16 years, the survival rate was 71% (39 of 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 post-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.
除肺移植（LT）外，对于造血干细胞移植（HCT）相关并发症（如闭塞性细支气管炎综合征（BOS））导致的终末期肺病，不存在特定的治疗方法。我们通过对本机构的一项回顾性病例系列研究以及医学文献综述，报告了因血液系统疾病接受HCT后接受LT的患者的适应证和结局。我们共确定了70例HCT后接受LT的病例，包括本机构9例在1990年至2010年间接受LT的异基因HCT受者。在我们的队列中，HCT时的中位年龄为16岁（范围10至35岁），LT时为34岁（范围17至44岁），HCT与LT之间的中位间隔为10年（范围2.9至27年）。LT的适应证包括肺纤维化（n = 4）、BOS（n = 3）、移植物抗宿主病（GVHD）相关的间质性肺炎（n = 1）和原发性肺动脉高压（n = 1）。中位生存期为49个月（范围2周至87个月），1例患者在LT后3年以上仍存活。LT后1年和5年的生存率分别为89%和37%。在1992年至2013年7月的医学文献中，我们确定了20篇文章，描述了来自美国、欧洲和亚洲不同中心的61例HCT后接受LT的病例。61例病例中有26例（43%）在LT时年龄<18岁。在大多数病例（80%；n = 49）中，BOS和肺部GVHD被列为LT的适应证，其次是肺纤维化和间质性肺病（20%；n = 12）。在报告3例或更多病例且随访间隔从术后即刻至16年的出版物中，生存率为71%（55例中的第39例）。大多数死亡归因于肺移植的长期并发症，包括感染和BOS。2例死亡与血液系统恶性肿瘤复发或复发有关。LT可以延长一些HCT后患有终末期肺部并发症患者的生存期。可能提高长期良好结局机会的患者因素包括年轻、HCT后至少2年无原血液系统恶性肿瘤复发，以及不存在需要用免疫抑制剂治疗的其他终末器官功能障碍或慢性GVHD表现。
