[Therapy of follicular lymphoma associated bronchiolitis obliterans with lung transplantation: 2 cases and literature review].

Objective: To summarize the clinical features of bronchiolitis obliterans (BO) associated with lymphoma or with lymphoma and paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome (PNP/PAMS), and to evaluate the feasibility of lung transplantation (LT) in these patients. Methods: All cases of BO associated with lymphoma diagnosed at China-Japan Friendship Hospital between January 2010 and January 2025 were included. A literature search was also conducted using the Wanfang and PubMed databases with the keywords "lymphoma" and "bronchiolitis obliterans" for articles published up to January 2025. The clinical characteristics, treatments, and outcomes of the patients were summarized and analyzed. Results: Four female patients with BO and lymphoma were identified from our center. Two patients underwent LT at 10 and 7 months after disease onset, respectively, and both showed marked improvement during the 6-12 month postoperative follow-up period. The other two patients, who did not receive LT, died. Postoperative pathological examination in Case 1 revealed Aspergillus infection and luminal occlusion throughout all levels of the airways. Among 23 additional cases identified from the literature, three had no evidence of PNP/PAMS, 19 were diagnosed with follicular lymphoma, and 20 died due to BO progression. The median time from symptom onset to death was 14 months (range: 2-51 months). Conclusion: BO associated with lymphoma and PNP/PAMS, or with lymphoma alone, carries a poor prognosis. LT may represent a viable and safe therapeutic option for selected patients with end-stage BO provided that the underlying lymphoma and PNP/PAMS are well-controlled. LT could improve quality of life and potentially prolong survival. Aspergillus infection may play a role in inducing or exacerbating BO.