Birgitta Versluijs

34 Lung transplantation in childhood cancer survivors Lung cancer as a second malignancy after childhood cancer treatment Childhood cancer survivors have a six fold increased relative risk for (second) malignan- cies compared to the general population. 46 Lung cancer is rarely reported as a second malignancy after treatment for childhood cancer. Amongst over 14,000 survivors only 11 cases were observed (cumulative incidence after 30 years 0.1%). Compared to the expec- ted rate in the general population the standardized incidence ratio (SIR) is 3.4 (CI 1.9- 6.1). The median time to lung cancer from diagnosis was 20.3 (14.0-25.6) years. As this is a rare event no risk factors have yet been identified, but the role of ionizing radiation as a carcinogen has been well reported in the literature. As this is a secondary malignancy that occurs late after treatment, one can assume that with longer follow up the incidence of lung cancer in childhood cancer survivors may increase. Lung transplantation in childhood cancer survivors Soubani reviewed the literature on lung transplantation (LT) following HCT. In total of 84 patients (median age at LT: 22 years (range 1-66), median time between HCT and LT: 52.3 months (range 6-240). Most patients were transplanted because of end stage Bronchiolitis Obliterans Syndrome (BOS). Survival rates of HCT survivors undergoing lung transplantation seem not to be different from general lung transplant recipients, with a 5 years survival of about 50%. Death from infection was more frequently seen in patients receiving lung transplantation after HCT. BOS in the transplanted lung occur- red in 32.5% of cases, this incidence is comparable with the incidence rate in other LT re- cipients. One of the main controversies about performing lung transplantation following HCT is the best timing of transplant in view of risk of relapse of underlying disease. In the reported series, relapse rate was relatively low (2.5%). This may be a result of proper timing of LT, or of the protective role of cGvHD against relapse by a graft versus leukae- mia effect. 47 There are very little data on lung transplantation in children following treat- ment of malignancy without HCT. 48 Current international guidelines for the selection of lung transplant candidates exclude patients with a history of malignancy within 2 years, with significant comorbidity in other organs and with chest abnormalities (International Society of Heart and Lung Transplantation 2006). All these items are relevant in child- hood cancer survivors with end stage lung disease. 2