Living-Donor Lobar Lung Transplantation for Broncho-Bronchiolitis Obliterans after Allogeneic Hematopoietic Stem Cell Transplantation: Does Bronchiolitis Obliterans Recur in Transplanted Lungs?

Abstract

We report a successful case of living-donor lobar lung transplantation (LDLLT) for therapy-resistant broncho-bronchiolitis obliterans (BBO) after allogeneic hematopoietic stem cell transplantation (HSCT). Bronchiolitis obliterans (BO) is one of the late-onset noninfectious pulmonary complications that occur after allogeneic HSCT and is usually resistant to immunosuppressive therapy. A 17-year-old girl with acute lymphoblastic leukemia (ALL) had undergone allogeneic bone marrow transplantation (BMT) from an HLA-matched sibling in 1997. Five years later, she relapsed with ALL and was treated with chemotherapy following stem cell rescue and donor lymphocyte infusion from the original BMT donor. Eight months later, BBO resistant to immunosuppressive therapies, including rituximab, developed in combination with chronic graft-versus-host disease (GVHD). In February 2004, the patient underwent LDLLT from 2 other family members who were mismatched at 3 HLA loci. The patient has been in good health for more than 30 months following LDLLT and shows no sign of BBO in the transplanted lungs, just as with other patients who have undergone lung transplantation for BO associated with chronic GVHD. LDLLT may therefore be considered a viable therapeutic option for the treatment of BO after allogeneic HSCT.

Epstein-Barr virus-associated post-transplantation lymphoproliferative disorder as a complication after cadaveric lung transplantation following allogeneic hematopoietic stem cell transplantation

“…3,13,14 The recipients of LDLLT following allo-HSCT from the same donor may require little or no immunosuppressive therapy. [13][14][15] It has been reported that the rate of PTLD, as a complication of LDLLT after allo-HSCT, was 10.5% in Japan. 13 The incidence of de novo malignancy after lung transplantation, including PTLD, appeared to be higher in patients after allo-HSCT.…”

Rituximab Monotherapy and Rituximab-Containing Chemotherapy Were Effective for Paraneoplastic Pemphigus Accompanying Follicular Lymphoma, but not for Subsequent Bronchiolitis Obliterans

“…Even in Japan, it has recently been reported that lung transplantation for a patient with BO after allogeneic stem cell transplantation was successful. 16,17 However, it is difficult to find donors for lung transplantation because only a few are available and lung transplantation for cancer patients is not generally accepted in Japan. Therefore, living-donor lobar lung transplantation from family members might be the best choice for rescuing Japanese patients with BO accompanied by PNP.…”

Prophylactic and therapeutic treatment of graft-versus-host disease in Japan

“…However, successful cases of living-donor lobar lung transplantation (LDLLT) have been reported [155,156]. Given a severe deficit of cadaveric donor organs, LDLLT is performed for various lung diseases including BOS after HSCT in Japan [157].…”