Increased risk for lymphoid and myeloid neoplasms in elderly solid-organ transplant recipients.
BACKGROUND
By assessing the spectrum of hematologic malignancies associated with solid-organ transplantation in the elderly, we provide information on the pathogenesis of lymphoid and myeloid neoplasms and the clinical manifestations of immunosuppression.


METHODS
Using data from the U.S. Surveillance, Epidemiology, and End Results Medicare database, we identified 83,016 cases with a hematologic malignancy (age 66-99 years) and 166,057 population-based controls matched to cases by age, sex, and calendar year. Medicare claims were used to identify a history of solid-organ transplantation. We used polytomous logistic regression to calculate odds ratios (OR) comparing transplantation history among cases with various hematologic malignancy subtypes and controls, adjusting for the matching factors and race.


RESULTS
A prior solid-organ transplant was identified in 216 (0.26%) cases and 204 (0.12%) controls. Transplantation was associated with increased risk for non-Hodgkin lymphomas [OR, 2.13; 95% confidence interval (95% CI), 1.67-2.72], especially diffuse large B-cell lymphoma (OR, 3.29; 95% CI, 2.28-4.76), marginal zone lymphoma (OR, 2.48; 95% CI, 1.17-5.22), lymphoplasmacytic lymphoma (OR, 3.32; 95% CI, 1.41-7.81), and T-cell lymphoma (OR, 3.07; 95% CI, 1.56-6.06). Transplantation was also associated with elevated risk of Hodgkin lymphoma (OR, 2.53; 95% CI, 1.01-6.35) and plasma cell neoplasms (OR, 1.91; 95% CI, 1.24-2.93). Risks for myeloid neoplasms were also elevated (OR, 1.99; 95% CI, 1.41-2.81).


CONCLUSIONS
Solid-organ transplantation is associated with a wide spectrum of hematologic malignancies in the elderly. Risk was increased for four specific non-Hodgkin lymphoma subtypes for which a viral agent has been implicated, supporting an added role for immunosuppression.


CONCLUSIONS
Our results support monitoring for a wide spectrum of hematologic malignancies following solid-organ transplant.
Quinlan
Scott C
SC
Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, 6120 Executive Boulevard, EPS 7076, Rockville, MD 20892, USA.
Morton
Lindsay M
LM
Pfeiffer
Ruth M
RM
Anderson
Lesley A
LA
Landgren
Ola
O
Warren
Joan L
JL
Engels
Eric A
EA
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006689:Hodgkin Disease / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000209:etiology* / Q000473:pathology; D008297:Male; D054219:Neoplasms, Plasma Cell / Q000209:etiology* / Q000473:pathology; D016377:Organ Transplantation / Q000009:adverse effects*; D012307:Risk Factors; D018426:SEER Program
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