Lung transplantation for bronchiolitis obliterans syndrome after allo-SCT

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.

MeSH terms

  • Adolescent
  • Adult
  • Bronchiolitis Obliterans / epidemiology
  • Bronchiolitis Obliterans / surgery*
  • Child
  • Female
  • Graft vs Host Disease / epidemiology
  • Graft vs Host Disease / etiology
  • Hematologic Neoplasms / surgery
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hematopoietic Stem Cell Transplantation / methods*
  • Hematopoietic Stem Cell Transplantation / statistics & numerical data
  • Humans
  • Lung Transplantation / adverse effects
  • Lung Transplantation / methods*
  • Lung Transplantation / statistics & numerical data
  • Male
  • Middle Aged
  • Scandinavian and Nordic Countries / epidemiology
  • Survival Analysis
  • Young Adult