Abstract
Objectives
Pulmonary complications after hematopoietic stem cell transplantation (HSCT) are associated
with poor survival and can be treated by lung transplantation (LT). However, the indications
for LT in patients with pulmonary complications after HSCT remain unclear due to low
number of cases. HSCT is frequently conducted for hematologic malignancies, which
have different recurrence patterns from solid-organ malignancies. Some patients also
experience ABO blood type changes post-HSCT. This study aimed to reassess the indication
of LT for pulmonary complications post-HSCT, focusing on disease-free interval (DFI)
and ABO-incompatibility.
Methods
Retrospective chart reviews were performed in patients who underwent LT for post-HSCT
pulmonary complications. In patients with previous hematologic malignancy, indication
was based on estimated recurrence rate instead of DFI. Donors were selected based
on the recipient anti-A/B antibody profile rather than ABO type. Post-LT survival
and complication rates were examined.
Results
Forty consecutive patients undergoing LT after HSCT (including 31 with previous hematologic
malignancy) were analyzed. The median DFI between HSCT and LT was 64.5 months. Thirteen
patients with previous hematologic malignancy had DFI <5 years but none experienced
recurrence. There was no significant difference in 5-year post-LT survival between
patients undergoing (74.7%) and not undergoing HSCT (68.4%). There was no significant
difference in survival between patients with DFI ≥5 years (63.8%) and patients with
DFI <5 years (83.3%). Five patients underwent LTs from major ABO-incompatible donors,
but none developed incompatibility-related complications.
Conclusions
Indications based on estimated recurrence rates and recipients' anti-A/B antibody
profiles may increase the use of LT for patients after HSCT.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
BOS (bronchiolitis obliterans syndrome), CI (confidence interval), DFI (disease-free interval), GVHD (graft-versus-host disease), HSCT (hematopoietic stem cell transplantation), IPS (idiopathic pneumonia syndrome), LDLLT (living-donor lobar lung transplantation), LT (lung transplantation), PTLD (post-transplant lymphoproliferative disorder)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Thoracic and Cardiovascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends in use of and survival after autologous hematopoietic cell transplantation in North America, 1995-2005: significant improvement in survival for lymphoma and myeloma during a period of increasing recipient age.Biol Blood Marrow Transplant. 2013; 19: 1116-1123
- Reduced mortality after allogeneic hematopoietic-cell transplantation.N Engl J Med. 2010; 363: 2091-2101
- Late-onset noninfectious pulmonary complications after allogeneic stem cell transplantation are significantly associated with chronic graft-versus-host disease and with the graft-versus-leukemia effect.Blood. 2003; 102: 4236-4242
- Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation.Bone Marrow Transplant. 2001; 28: 425-434
- Late-onset non-infectious pulmonary complications following allogeneic hematopoietic stem cell transplantation in children.Bone Marrow Transplant. 2009; 44: 303-308
- Incidence, outcome, and risk factors of late-onset noninfectious pulmonary complications after unrelated donor stem cell transplantation.Bone Marrow Transplant. 2004; 33: 751-758
- Bronchiolitis obliterans in chronic graft-versus-host disease: analysis of risk factors and treatment outcomes.Biol Blood Marrow Transplant. 2003; 9: 657-666
- Lung transplantation in a patient with a prior bone marrow transplant.Chest. 1992; 102: 948
- Outcomes of lung transplantation after allogeneic hematopoietic stem cell transplantation.Biol Blood Marrow Transplant. 2014; 20: 1169-1175
- Dichotomy in pulmonary graft-versus-host disease evident among allogeneic stem-cell transplant recipients undergoing lung transplantation.Eur Respir J. 2016; 48: 1807-1810
- Prognostic factors in lung transplantation after hematopoietic stem cell transplantation.Transplantation. 2018; 102: 154-161
- A consensus document for the selection of lung transplant candidates: 2014—an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation.J Heart Lung Transplant. 2015; 34: 1-15
- Less maintenance immunosuppression in lung transplantation following hematopoietic stem cell transplantation from the same living donor.Am J Transplant. 2011; 11: 1509-1516
- Analysis of longitudinal changes in dyspnea of patients with chronic obstructive pulmonary disease: an observational study.Respir Res. 2012; 13: 85
- Prevalence of hematopoietic cell transplant survivors in the United States.Biol Blood Marrow Transplant. 2013; 19: 1498-1501
- Outcome of patients with distinct molecular genotypes and cytogenetically normal AML after allogeneic transplantation.Blood. 2015; 17: 2062-2069
- Relapse of AML after hematopoietic stem cell transplantation: methods of monitoring and preventive strategies. A review from the ALWP of the EBMT.Bone Marrow Transplant. 2016; 51: 1431-1438
- An exploration of the applicability of the refined disease risk index and its integration with other independent risk factors for individualized prognostication.Bone Marrow Transplant. 2017; 52: 363-371
- Graft versus leukemia reactions after bone marrow transplantation.Blood. 1990; 75: 555-562
- Kinetics and risk factors of relapse after allogeneic stem cell transplantation in children with leukemia: a long-term follow-up single center study.Biol Blood Marrow Transplant. 2019; 25: 100-106
- Sensitivity of hematological malignancies to graft-versus-host effects: an EBMT megafile analysis.Leukemia. 2014; 28: 2235-2240
- ABO-incompatibility in solid organ transplantation.Transfus Med. 2001; 11: 325-342
- Levels of anti-A/B antibodies after ABO-incompatible hematopoietic stem cell transplantation.Transplant Proc. 2005; 37: 1385-1387
Article info
Publication history
Published online: October 28, 2020
Accepted:
October 12,
2020
Received in revised form:
October 8,
2020
Received:
February 27,
2020
Identification
Copyright
© 2020 by The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: Evidence over dogma: Lung transplant for posthematopoietic stem cell transplant related pulmonary failureThe Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 4
- PreviewRecent malignancy within 2 years has been deemed an absolute contraindication to lung transplant listing ever since the first edition of the recipient selection guidelines put forth by the International Society for Heart and Lung Transplantation in 1998.1 In their most recent consensus from 2014, hematologic malignancies are specified among others in whom a disease-free interval (DFI) of 5 years is recommended.2 Noguchi and colleagues3 in their recent study sought to demonstrate that, with appropriate selection based on estimated recurrence rates, patients with previous hematologic malignancies treated with hematopoietic stem cell transplant (HSCT) can safely undergo lung transplant without reaching a 5-year DFI.
- Full-Text
- Preview
- Commentary: Selection criteria for lung transplantation—is there room for individualization?The Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 4
- PreviewAccording to current guidelines, a recent malignancy is a clear contraindication for lung transplantation (LTx).1 As the risk for tumor progression/early recurrence is considered greater in immunosuppressed patients, a tumor-free interval of 5 years is recommended for most malignancies before listing. Only for nonmelanoma skin cancer can this time interval be reduced to 2 years. In this issue of the Journal, Noguchi and colleagues2 summarized the Japanese experience of LTx for patients who developed pulmonary complications after hematopoietic stem cell transplantation.
- Full-Text
- Preview
- Commentary: The jury is out—expanding eligibility for lung transplantation after hematopoietic stem cell transplantationThe Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 4
- PreviewOver the last 30 years, early mortality after allogeneic hematopoietic stem cell transplantation (HSCT) has declined, with a consequent increase in long-term morbidity.1 Among late post-HSCT complications are noninfectious pulmonary complications, including bronchiolitis obliterans, which typically occur within 2 years after HSCT and portend a 5-year survival probability of <15%.2,3 Medical management is of limited efficacy in this setting, and lung transplantation (LTx) has emerged as a potential therapy for select patients.
- Full-Text
- Preview
