Successful Lung Transplantation in A Patient With Pre-Existing Chronic Myeloid Leukemia Treated With Imatinib: A Case...

Although active malignancy is a contraindication to lung transplantation, there is increasing uncertainty as to what constitutes "active" malignancy given the rapidly changing therapeutic armamentarium and overall survival of patients with malignancy. Chronic myeloid leukemia (CML) is an example of a previously fatal malignancy that has been transformed into a chronic disease with close-to-normal life expectancy since the advent of tyrosine kinase inhibitor (TKI) therapy. However, it remains relatively unknown if lung transplantation could successfully be performed in patients with CML. We describe the course of a 34-year-old woman with cystic fibrosis and advanced lung disease who was diagnosed with CML while undergoing lung transplant evaluation. She was initiated on imatinib with optimal treatment response; she achieved major molecular response (MMR) and deep molecular response (DMR) at 8 and 10 months of treatment, respectively. She developed progressive respiratory failure and underwent bilateral lung transplantation at close to 3 years after achieving MMR. At 6 years post-transplant, she has excellent graft function and remains in DMR on imatinib. Treated CML in DMR should be regarded as inactive malignancy and should not preclude patients from life-saving transplant consideration. Our case also demonstrates the feasibility of long-term immunosuppression on TKI therapy.