*Purpose: Malignancy is generally a contraindication to lung transplantation (LTx). Few reports describe clinical outcomes in patients undergoing solid-organ transplantation with indolent hematologic malignancy. We sought to report our experience in performing LTx in a patient with chronic lymphocytic leukemia (CLL).

*Methods: We report a case of a 71-year-old male with a past medical history significant for coronary artery bypass grafting with the left internal mammary artery, who underwent single right LTx for idiopathic pulmonary fibrosis and was diagnosed with CLL after the transplant hospitalization.

*Results: Patient had an uncomplicated postoperative stay and was discharged on postoperative day 8. Two weeks following the transplant hospitalization, he reported for a routine follow-up visit where an elevated white blood cell (WBC) count in the range of 13,000-15,000 per mm³ was noted, despite antibiotics. Review of records revealed a two-year history of leukocytosis with WBC counts reaching 20,000 per mm³. Patient denied any symptoms of unexplained fevers, chills, or drenching night sweats. He reported recent dyspnea with exertion and 10-pound weight loss, likely attributed to receiving nutritional support via percutaneous endoscopic gastrostomy in the days following transplant. An extensive infectious disease work-up was unremarkable, and he was referred to hematology. Results of flow-based immunophenotypic testing indicated a diagnosis of CLL (Rai Stage 0); recent computed tomographic chest abdomen pelvis (CT CAP) examination was negative for lymphadenopathy. Fluorescence in situ hybridization revealed homozygous deletion of chromosome 13q14.2 (marker D13S319). No treatment was pursued given the early stage and good prognosis. No changes were made in his immunosuppressive regimen. Patient continued to complain of progressive dyspnea and presented with right pleural effusion a few weeks later. Flow cytometry of the effusion detected 9% CLL cells. We continued with close surveillance, and subsequent CT CAP revealed an abdominal tumor, most consistent with a carcinoid tumor. The patient is pending Octreotide scan for confirmation.

*Conclusions: CLL should not be viewed as an absolute contraindication to LTx. On the basis of our findings in this patient, we propose further investigation for the transplant of patients with indolent hematologic malignancy and adaptation of candidacy selection guidelines.

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