Abstract CT257: Double lung transplantation in patients with recent history of malignancy

Abstract Introduction: Recent history of malignancy usually within five years is a contraindication for double lung transplantation (DLT). However, the relationship between a recent history of malignancy and lung transplantation outcomes is unclear. Method: Patients with respiratory failure and a history of cancer in the last five years treated with DLT were identified between 09/2021 and 1/2026. All patients had enrolled in the DLT registry aimed for lung-limited malignancies (DREAM) study cohort C (NCT05671887). Exclusion criteria included the presence of extrapulmonary metastatic disease and medical ineligibility for DLT. Standard staging work-up confirmed the absence of distant metastasis. All patients were followed up with computed tomography every 12 weeks. Results: 19 consecutive patients who underwent DLT were included (age 27-74, 12 male, 7 female, and 13 former smokers). 11 lung (stage IA2-IIIB), three prostate (stage I-IIc), two testicular, one breast, one bladder, and one skin cancer cases were included. Among lung cancer patients, six patients had adenocarcinoma, four squamous cell carcinoma, and one poorly differentiated non-small cell carcinoma. Prior to DLT, patients received radioimmunotherapy (n=1), chemoradiotherapy (n=2), chemoradiotherapy plus immunotherapy (IO) (n=2), radiotherapy alone (n=3), and chemotherapy alone (n=3). The duration of IO was a median of 2 (2-18) months. The IO-free interval was 11, 27, and 44 months before DLT. All patients had high oxygen requirements before DLT. The indications for DLT were COPD (n=5), IO-related ILD (n=3), IPF (n=2), and COVID-related ILD (n=1). Transplant rejection did not occur, and all patients were discharged on room air. The median overall survival after transplantation was 21 (6-59) months. 3 patients passed away at 9, 6, and 6 months post-DLT (2 died of respiratory failure, 1 died of cardiac arrest). 2 patients had new primary cancers which were surgically resected (1 had pancreatic cancer, 1 had prostate cancer). Conclusion: 19 patients, with a history of malignancy within 5 years, successfully underwent DLT for non-malignant indications of respiratory failure without significant complications. Ongoing DREAM study cohort C will continue to investigate the role of DLT in patients with a recent history of malignancy. Citation Format: Young Kwang Chae, Liam IL-Young Chung, Ronald Min, Sanghwa Kim, Ben Ponvilawan, Chan Mi Jung, Yuchan Kim, Brooke Sanson, Rose Dwyer, Carolyn Moloney, Tarik Demir, Chitaru Kurihara, Ambalavanan Arunachalam, Ankit Bharat. Double lung transplantation in patients with recent history of malignancy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(8_Suppl):Abstract nr CT257.