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Chronic Lymphocytic Leukemia in Lung Transplant

Rafid Fadul, MD; Shijing Jia, MD; Ali Ataya, MD; Carol Farver, MD; Marie Budev, DO
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Cleveland Clinic Foundation, Cleveland, OH


Chest. 2013;144(4_MeetingAbstracts):895A. doi:10.1378/chest.1664718
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Abstract

SESSION TITLE: Miscellaneous Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Malignancy is generally a contraindication to lung transplantation (LT). Indolent hematologic malignancy has not been a contraindication in other solid organ transplantation and outcomes have been variable. We present the first reported experience of lung transplant in the setting of chronic lymphocytic leukemia (CLL).

CASE PRESENTATION: This is a single-center retrospective, cohort analysis of 1158 LT recipients, of which three patients had CLL. Data collected included demographics, pathology, and post-LT outcomes. Mean age at transplant was 59 years (range 55 to 62) for the underlying diagnoses of chronic obstructive pulmonary disorder (COPD) and pulmonary fibrosis. In two cases, diagnosis of CLL was made prior to LT while the third instance was approximately two months after LT. All three patients were Stage 0 by Rai staging system at diagnosis and none required therapy. Bone marrow demonstrated low grade B-cell CLL/small lymphocytic lymphoma in two patients and B-cell CLL in the third. One patient experienced infectious pulmonary manifestations (i.e. Pseudomonas Aeruginosa pneumonia and effusion) in the setting of hypogammaglobulinemia, a documented risk factor for infectious pulmonary complications in patients with CLL. Two patients each had one episode of A2 rejection within one year of LT. A standard maintenance immunosuppressive regimen of tacrolimus and mycophenalate mofetil was utilized. Induction therapy with antithymocyte globulin was used in only one case. At three years, survival was 100%. The patient with underlying COPD developed non-small cell lung cancer with features of poorly differentiated adenocarcinoma and ultimately died four years after LT. The other two patients have survived at time of writing. None of the three patients have experienced recurrence or complications of CLL.

DISCUSSION: This is the first documented series of outcomes in CLL with LT. Our patients experienced excellent survival without malignant conversion. These patients also did not require significant alteration in the immunosuppressive regimen.

CONCLUSIONS: Further, it demonstrates that indolent hematologic malignancy should not be viewed as an absolute contraindication to LT.

Reference #1: Wilkinson AH, Smith JL, et al. Increased frequency of posttransplant lymphoma in patients treated with cyclosporine, azathioprine, and prednisone. Transplantation;1989:2;293-296.

Reference #2: Romero RA, Reddy KS, et al. Simultaneous Kidney-Pancreas Transplantation in a patient with Small Lymphocytic Leukemia. Transplantation: 2003;75:414-423.

DISCLOSURE: The following authors have nothing to disclose: Rafid Fadul, Shijing Jia, Ali Ataya, Carol Farver, Marie Budev

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