Soubani Ayman O, Kingah Pascal, Alshabani Khaled, Muma Gilbert, Haq Athar
Division of Pulmonary, Critical Care and Sleep Medicine, Karmanos Cancer Center, School of Medicine, Wayne State University, Detroit, MI, USA.
Clin Transplant. 2014 Jul;28(7):776-82. doi: 10.1111/ctr.12378. Epub 2014 May 21.
Non-infectious pulmonary complications following hematopoietic stem cell transplantation (HSCT) are major cause of morbidity and mortality with limited treatment options. Lung transplantation (LT) has been rarely reported as a treatment option for selected HSCT recipients with these problems.
Describe the outcome of HSCT recipients who underwent LT.
Two cases of LT following HSCT from our institution are presented. Cases reported in literature were identified using English language PubMed/MEDLINE with keywords hematopoietic stem cell transplantation, bone marrow transplantation, or bronchiolitis obliterans cross-referenced with lung transplantation. We extracted data on baseline characteristics and survival data following LT.
Total of 84 patients are analyzed. Age at time of LT was median of 22 yr (range 1-66). Seventy-nine patients were recipients of allogeneic HSCT. The indications for LT were bronchiolitis obliterans syndrome (BOS; 63 patients), pulmonary fibrosis (13 patients), BOS/pulmonary fibrosis (five patients), and graft-versus-host-disease (GVHD) of lung (three patients). The median time between HSCT and LT was 52.3 months (range 6-240). The median follow-up after LT was 36 months (range 0-168). During this time, BOS was documented in 25 patients. Relapse of hematological malignancy was reported in two patients, and new malignancy developed in four patients. At the end of follow-up, 60 patients were alive and 24 patients died. The probability of survival following LT at 24 and 36 months was 0.88 (95% CI 0.78-0.93) and 0.79 (95% CI 0.67-0.87), respectively.
LT is a potential therapeutic option in selected patients with severe chronic pulmonary disease following HSCT. Further studies are needed to determine the appropriate timing and the outcome of this approach.
造血干细胞移植（HSCT）后的非感染性肺部并发症是发病和死亡的主要原因，治疗选择有限。肺移植（LT）作为治疗这些问题的选定HSCT受者的一种选择，鲜有报道。
描述接受LT的HSCT受者的结局。
介绍了我们机构的2例HSCT后LT病例。使用英文PubMed/MEDLINE，通过关键词造血干细胞移植、骨髓移植或闭塞性细支气管炎与肺移植交叉索引，确定文献中报道的病例。我们提取了LT后的基线特征数据和生存数据。
共分析了84例患者。LT时的年龄中位数为22岁（范围1 - 66岁）。79例患者接受了异基因HSCT。LT的指征为闭塞性细支气管炎综合征（BOS；63例患者）、肺纤维化（13例患者）、BOS/肺纤维化（5例患者）和肺部移植物抗宿主病（GVHD）（3例患者）。HSCT与LT之间的中位时间为52.3个月（范围6 - 240个月）。LT后的中位随访时间为36个月（范围0 - 168个月）。在此期间，25例患者记录有BOS。2例患者报告血液系统恶性肿瘤复发，4例患者出现新的恶性肿瘤。随访结束时，60例患者存活，24例患者死亡。LT后24个月和36个月的生存概率分别为0.88（95%CI 0.78 - 0.93）和0.79（95%CI 0.67 - 0.87）。
LT是选定的HSCT后严重慢性肺部疾病患者的一种潜在治疗选择。需要进一步研究以确定这种方法的合适时机和结局。
