Risk of myeloid neoplasms after solid organ transplantation

Details

• Alternative Title:
  Leukemia
• Personal Author:
  Morton, Lindsay M. ; Gibson, Todd M. ; Clarke, Christina A. ; Lynch, Charles F. ; Anderson, Lesley A. ; Pfeiffer, Ruth ; Landgren, Ola ; Weisenburger, Dennis D. ; Engels, Eric A.
• Description:
  Solid organ transplant recipients have elevated cancer risks, owing in part to pharmacologic immunosuppression. However, little is known about risks for hematologic malignancies of myeloid origin. We linked the US Scientific Registry of Transplant Recipients with 15 population-based cancer registries to ascertain cancer occurrence among 207 859 solid organ transplants (1987-2009). Solid organ transplant recipients had a significantly elevated risk for myeloid neoplasms, with standardized incidence ratios (SIRs) of 4.6 (95% confidence interval 3.8-5.6; N=101) for myelodysplastic syndromes (MDS), 2.7 (2.2-3.2; N=125) for acute myeloid leukemia (AML), 2.3 (1.6-3.2; N=36) for chronic myeloid leukemia and 7.2 (5.4-9.3; N=57) for polycythemia vera. SIRs were highest among younger individuals and varied by time since transplantation and organ type (Poisson regression P<0.05 for all comparisons). Azathioprine for initial maintenance immunosuppression increased risk for MDS (P=0.0002) and AML (2-5 years after transplantation, P=0.0163). Overall survival following AML/MDS among transplant recipients was inferior to that of similar patients reported to US cancer registries (log-rank P<0.0001). Our novel finding of increased risks for specific myeloid neoplasms after solid organ transplantation supports a role for immune dysfunction in myeloid neoplasm etiology. The increased risks and inferior survival should heighten clinician awareness of myeloid neoplasms during follow-up of transplant recipients.
• Subjects:
  Adolescent Adult Aged Aged, 80 And Over Child Child, Preschool Female Humans Incidence Infant Infant, Newborn Leukemia, Myeloid Male Middle Aged Mortality Organ Transplantation Registries Risk Young Adult

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• Source:
  Leukemia. 28(12):2317-2323.
• Pubmed ID:
  24727673
• Pubmed Central ID:
  PMC4197126
• Document Type:
  Journal Article
• Funding:
  HHSN261201000037C/CA/NCI NIH HHS/United States ; HHSN261201000027C/CA/NCI NIH HHS/United States ; ZIA CP010170-11/Intramural NIH HHS/United States ; N01PC35143/CA/NCI NIH HHS/United States ; U58 DP000805/DP/NCCDPHP CDC HHS/United States ; U58 DP000817/DP/NCCDPHP CDC HHS/United States ; HHSN261201000035C/CA/NCI NIH HHS/United States ; P30 ES005605/ES/NIEHS NIH HHS/United States ; P30 CA086862/CA/NCI NIH HHS/United States ; HHSN261201000036C/CA/NCI NIH HHS/United States ; N01PC35137/CA/NCI NIH HHS/United States ; U58 DP000807/DP/NCCDPHP CDC HHS/United States ; U58 DP000808/DP/NCCDPHP CDC HHS/United States ; N01PC35142/CA/NCI NIH HHS/United States ; Z99 CA999999/Intramural NIH HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; U58 DP000848/DP/NCCDPHP CDC HHS/United States ; U58 DP000812/DP/NCCDPHP CDC HHS/United States ; HHSN261201000024C/CA/NCI NIH HHS/United States ; HHSN261201000034C/CA/NCI NIH HHS/United States ; N01PC54405/CA/NCI NIH HHS/United States ; U58 DP000832/DP/NCCDPHP CDC HHS/United States ; N01PC35139/CA/NCI NIH HHS/United States ; HHSN261201000026C/CA/NCI NIH HHS/United States ; U58 DP000824/DP/NCCDPHP CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  28
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8ad96c7a89aced46de88e1ee944790a92b5179cbad3129d4a90d794e0859e8d4
• Download URL:
  https://stacks.cdc.gov/view/cdc/41988/cdc_41988_DS1.pdf
• File Type:
  [PDF - 1.10 MB ]