Melanoma risk and survival among organ transplant recipients

Details

• Alternative Title:
  J Invest Dermatol
• Personal Author:
  Robbins, Hilary A. ; Clarke, Christina A. ; Arron, Sarah T. ; Tatalovich, Zaria ; Kahn, Amy R. ; Hernandez, Brenda Y. ; Paddock, Lisa ; Yanik, Elizabeth L. ; Lynch, Charles F. ; Kasiske, Bertram L. ; Snyder, Jon ; Engels, Eric A.
• Description:
  Solid organ transplant recipients, who are medically immunosuppressed to prevent graft rejection, have increased melanoma risk, but risk factors and outcomes are incompletely documented. We evaluated melanoma incidence among 139,991 non-Hispanic white transplants using linked US transplant-cancer registry data (1987-2010). We used standardized incidence ratios (SIRs) to compare incidence with the general population and incidence rate ratios (IRRs) from multivariable Poisson models to assess risk factors. Separately, we compared post-melanoma survival among transplant recipients (n=182) and non-recipients (n=131,358) using multivariable Cox models. Among transplant recipients, risk of invasive melanoma (n=519) was elevated (SIR=2.20, 95% CI 2.01-2.39), especially for regional stage tumors (SIR=4.11, 95% CI 3.27-5.09). Risk of localized tumors was stable over time after transplantation but higher with azathioprine maintenance therapy (IRR=1.35, 95% CI 1.03-1.77). Risk of regional/distant stage tumors peaked within 4 years following transplantation and increased with polyclonal antibody induction therapy (IRR=1.65, 95% CI 1.02-2.67). Melanoma-specific mortality was higher among transplant recipients than non-recipients (hazard ratio 2.98, 95% CI 2.26-3.93). Melanoma exhibits increased incidence and aggressive behavior under transplant-related immunosuppression. Some localized melanomas may result from azathioprine, which acts synergistically with UV radiation, whereas T-cell-depleting induction therapies may promote late-stage tumors. Our findings support sun safety practices and skin screening for transplant recipients.
• Subjects:
  Adult Age Factors Case-Control Studies Cause Of Death Confidence Intervals Disease-Free Survival Female Humans Immunocompromised Host Incidence Male Melanoma Middle Aged Multivariate Analysis Neoplasm Invasiveness Neoplasm Staging Organ Transplantation Poisson Distribution Proportional Hazards Models Registries Risk Assessment Sex Factors Skin Neoplasms Survival Analysis Transplant Recipients

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• Source:
  J Invest Dermatol. 135(11):2657-2665
• Pubmed ID:
  26270022
• Pubmed Central ID:
  PMC4640996
• Document Type:
  Journal Article
• Funding:
  U58 DP003931/DP/NCCDPHP CDC HHSUnited States/ ; N01PC35143/CA/NCI NIH HHSUnited States/ ; 5458DP003920/DP/NCCDPHP CDC HHSUnited States/ ; U58 DP000848-04/DP/NCCDPHP CDC HHSUnited States/ ; 5U58/DP003931-02/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201300071C/CA/NCI NIH HHSUnited States/ ; U58 DP003920/DP/NCCDPHP CDC HHSUnited States/ ; 1U58 DP000807-01/DP/NCCDPHP CDC HHSUnited States/ ; U58 DP000848/DP/NCCDPHP CDC HHSUnited States/ ; 5U58DP003883-03/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201000037C/CA/NCI NIH HHSUnited States/ ; 5U58DP000824-04/DP/NCCDPHP CDC HHSUnited States/ ; N01-PC-35142/PC/NCI NIH HHSUnited States/ ; N01-PC-35137/PC/NCI NIH HHSUnited States/ ; U58 DP003883/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; N01-PC-35139/PC/NCI NIH HHSUnited States/ ; U58DP000832/DP/NCCDPHP CDC HHSUnited States/ ; U58 DP003875/DP/NCCDPHP CDC HHSUnited States/ ; U58DP003879/DP/NCCDPHP CDC HHSUnited States/ ; P30 CA086862/CA/NCI NIH HHSUnited States/ ; N01-PC-2013-00021/PC/NCI NIH HHSUnited States/ ; HHSN261201000036C/CA/NCI NIH HHSUnited States/ ; U58 DP003879/DP/NCCDPHP CDC HHSUnited States/ ; U58DP12-1205 3919-03/DP/NCCDPHP CDC HHSUnited States/ ; N01PC35137/CA/NCI NIH HHSUnited States/ ; HHSN261201300011C/RC/CCR NIH HHSUnited States/ ; U58 DP000807/DP/NCCDPHP CDC HHSUnited States/ ; N01PC35142/CA/NCI NIH HHSUnited States/ ; Z99 CA999999/ImNIH/Intramural NIH HHSUnited States/ ; HHSN261201300021C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; 5U58DP003921-03/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201000024C/CA/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003921/DP/NCCDPHP CDC HHSUnited States/ ; 5U58DP003875-01/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201300011I/CA/NCI NIH HHSUnited States/ ; U58 DP000832/DP/NCCDPHP CDC HHSUnited States/ ; N01PC35139/CA/NCI NIH HHSUnited States/ ; N01-PC-35143/PC/NCI NIH HHSUnited States/ ; U58 DP000824/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  135
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:1862af5b42227f0096adc5b88f258aa106f2ad19618db4c0647099342873fe45
• Download URL:
  https://stacks.cdc.gov/view/cdc/37887/cdc_37887_DS1.pdf
• File Type:
  [PDF - 279.29 KB ]