title: Burkitt lymphoma risk in U.S. solid organ transplant recipients.
abstract: Case reports of Burkitt lymphoma (BL) in transplant recipients suggest that the risk is markedly elevated. Therefore, we investigated the incidence of BL in 203,557 solid organ recipients in the U.S. Transplant Cancer Match Study (1987-2009) and compared it with the general population using standardized incidence ratios. We also assessed associations with demographic and clinical characteristics, and treatments used to induce therapeutic immunosuppression. BL incidence was 10.8 per 100,000 person-years, representing 23-fold (95% confidence interval (CI) 19-28) greater risk than in the general population, and it peaked 3-8 years after the time of transplantation. In adjusted analyses, BL incidence was higher in recipients transplanted when <18 vs. ≥35 years (incidence rate ratio [IRR] 3.49, 95% CI 2.08-5.68) and in those transplanted with a liver (IRR 2.91, 95% CI 1.68-5.09) or heart (IRR 2.39, 95% CI 1.30-4.31) compared with kidney. BL incidence was lower in females than males (IRR 0.45, 95% CI 0.28-0.71), in blacks than whites (IRR 0.33, 95% CI 0.12-0.74), in those with a baseline Epstein-Barr virus (EBV)-seropositive versus EBV-seronegative status (IRR 0.34, 95% CI 0.13-0.93), and in those treated with azathioprine (IRR 0.56, 95% CI 0.34-0.89) or corticosteroids (IRR 0.48, 95% CI 0.29-0.82). Tumors were EBV-positive in 69% of 32 cases with results. EBV positivity was 90% in those aged <18 years and 59% in those aged 18+ years. In conclusion, BL risk is markedly elevated in transplant recipients, and it is associated with certain demographic and clinical features. EBV was positive in most but not all BL cases with results.
authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. mbulaits@mail.nih.gov
authors: Sam M
authors: SM
authors: Mbulaiteye
authors: Christina A
authors: CA
authors: Clarke
authors: Lindsay M
authors: LM
authors: Morton
authors: Todd M
authors: TM
authors: Gibson
authors: Karen
authors: K
authors: Pawlish
authors: Dennis D
authors: DD
authors: Weisenburger
authors: Charles F
authors: CF
authors: Lynch
authors: Marc T
authors: MT
authors: Goodman
authors: Eric A
authors: EA
authors: Engels
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D044383:Black People; D002051:Burkitt Lymphoma / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects; D004854:Herpesvirus 4, Human; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008875:Middle Aged; D012042:Registries; D012306:Risk; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
references: Cell. 1983 Feb;32(2):311-5
references: 6402307
references: Am J Trop Med Hyg. 2011 Mar;84(3):397-401
references: 21363976
references: Proc Natl Acad Sci U S A. 1982 Dec;79(24):7824-7
references: 6961453
references: Pediatrics. 2008 Jun;121(6):e1470-7
references: 18519450
references: Semin Cancer Biol. 2009 Dec;19(6):347-50
references: 19607918
references: Nature. 1962 Apr 21;194:232-4
references: 13874900
references: Cancer. 1982 Mar 1;49(5):1016-22
references: 7059918
references: Blood. 2005 Aug 1;106(3):1031-6
references: 15840698
references: Blood. 2012 Dec 20;120(26):5181-4
references: 23091298
references: Semin Cancer Biol. 2009 Dec;19(6):351-65
references: 19619654
references: Int J Cancer. 2008 Mar 15;122(6):1319-23
references: 18000823
references: N Engl J Med. 1984 Aug 30;311(9):565-70
references: 6611504
references: Cancer Cell. 2012 Aug 14;22(2):167-79
references: 22897848
references: Br J Surg. 1958 Nov;46(197):218-23
references: 13628987
references: Int J Cancer. 2006 Dec 1;119(11):2685-91
references: 16929513
references: Cancer. 2012 Oct 1;118(19):4715-24
references: 22392525
references: Pediatr Blood Cancer. 2009 Sep;53(3):366-70
references: 19434731
references: Cancer. 2011 Oct 1;117(19):4540-50
references: 21446044
references: Cancer Epidemiol Biomarkers Prev. 2010 May;19(5):1229-37
references: 20406959
references: Int J Cancer. 2008 Dec 1;123(11):2658-63
references: 18767045
references: Nature. 2012 Oct 4;490(7418):116-20
references: 22885699
references: Int J Cancer. 2010 Apr 1;126(7):1732-9
references: 19810101
references: PLoS One. 2008 Jun 18;3(6):e2505
references: 18560562
references: Cancer Detect Prev. 1988;12(1-6):39-57
references: 3052837
references: Am J Transplant. 2009 Nov;9 Suppl 3:S1-155
references: 19845597
references: Blood. 2001 Jun 1;97(11):3370-9
references: 11369626
references: Blood. 2010 Dec 16;116(25):5600-4
references: 20813897
references: JAMA. 2011 Nov 2;306(17):1891-901
references: 22045767
references: Int J Cancer. 2008 Jul 1;123(1):187-94
references: 18435450