Association of Antibody Induction Immunosuppression with Cancer After Kidney Transplantation
Published Date:May 2015
Pubmed Central ID:PMC4405385
Funding:1U58 DP000807-01/DP/NCCDPHP CDC HHS/United States
5658DP000805-04/DP/NCCDPHP CDC HHS/United States
5U58/DP000808-05/DP/NCCDPHP CDC HHS/United States
5U58DP000812-03/DP/NCCDPHP CDC HHS/United States
5U58DP000817-05/DP/NCCDPHP CDC HHS/United States
5U58DP000824-04/DP/NCCDPHP CDC HHS/United States
HHSH234200537009C/PHS HHS/United States
HHSH250201000018C/PHS HHS/United States
HHSN261201000024C/PHS HHS/United States
HHSN261201000026C/PHS HHS/United States
HHSN261201000027C/PHS HHS/United States
HHSN261201000035C/PHS HHS/United States
HHSN261201000036C/PHS HHS/United States
HHSN261201000037C/PHS HHS/United States
N01-PC-35137/PC/NCI NIH HHS/United States
N01-PC-35139/PC/NCI NIH HHS/United States
N01-PC-35143/PC/NCI NIH HHS/United States
N01-PC-54405/PC/NCI NIH HHS/United States
U58 DP000848-04/DP/NCCDPHP CDC HHS/United States
U58DP000832/DP/NCCDPHP CDC HHS/United States
Z99 CA999999/Intramural NIH HHS/United States
Induction immunosuppression is a mainstay of rejection prevention after transplantation. Studies have suggested a connection between antibody induction agents and cancer development, potentially limiting important immunosuppression protocols.
We used a linkage of U.S. transplantation data and cancer registries to explore the relationship between induction and cancer after transplantation. 111,857 kidney recipients (1987–2009) in the Transplant Cancer Match Study, which links the Scientific Registry for Transplant Recipients and U.S. cancer registries, were included. Poisson regression models were used to estimate adjusted incidence rate ratios (aIRR) of non-Hodgkin lymphoma (NHL)and other cancers with increased incidence after transplantation (lung, colorectal, kidney, and thyroid cancers, plus melanoma).
2,763 cancers of interest were identified. Muromonab-CD3 was associated with increased NHL (aIRR=1.37, 95% CI 1.06–1.76). Alemtuzumab was associated with increased NHL (aIRR=1.79, 95% CI 1.02-1-3.14), colorectal cancer (aIRR=2.46, 95% CI 1.03–5.91), and thyroid cancer (aIRR=3.37, 95% CI 1.55–7.33). Polyclonal induction was associated with increased melanoma (aIRR=1.50, 95% CI 1.06–2.14).
Our findings highlight the relative safety with regard to cancer risk of the most common induction therapies, the need for surveillance of patients treated with alemtuzumab, and the possible role for increased melanoma screening for those patients treated with polyclonal anti-T cell induction.
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