title: Risk of myeloid neoplasms after solid organ transplantation.
abstract: 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.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Morton
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Gibson
authors.affiliation: 1] Cancer Prevention Institute of California, Fremont, CA, USA [2] Department of Health Research and Policy, Stanford Cancer Institute, Palo Alto, CA, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Clarke
authors.affiliation: Department of Epidemiology, University of Iowa, Iowa City, IA, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Lynch
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK.
authors.forename: L A
authors.initials: LA
authors.lastname: Anderson
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA.
authors.forename: R
authors.initials: R
authors.lastname: Pfeiffer
authors.affiliation: Multiple Myeloma Section, Metabolism Branch, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
authors.forename: O
authors.initials: O
authors.lastname: Landgren
authors.affiliation: Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: D D
authors.initials: DD
authors.lastname: Weisenburger
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Engels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007951:Leukemia, Myeloid / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016377:Organ Transplantation / Q000009:adverse effects*; D012042:Registries; D012306:Risk; D014481:United States / Q000453:epidemiology; D055815:Young Adult
references.citation: Chem Biol Interact. 2010 Mar 19;184(1-2):39-45
references.pmid: 20026017
references.citation: Lancet. 2007 Jul 7;370(9581):59-67
references.pmid: 17617273
references.citation: Haematologica. 2012 Jun;97(6):805-17
references.pmid: 22180424
references.citation: Cancer Epidemiol Biomarkers Prev. 2010 May;19(5):1229-37
references.pmid: 20406959
references.citation: Nephrol Nurs J. 2012 Nov-Dec;39(6):447-57
references.pmid: 23469411
references.citation: Am J Transplant. 2013 Jan;13 Suppl 1:1-7
references.pmid: 23237693
references.citation: Haematologica. 2005 May;90(5):691-3
references.pmid: 15921387
references.citation: Br J Cancer. 2009 Mar 10;100(5):822-8
references.pmid: 19259097
references.citation: Leukemia. 1998 Mar;12(3):346-52
references.pmid: 9529129
references.citation: Blood. 2009 Jul 16;114(3):630-7
references.pmid: 19443660
references.citation: JAMA. 2001 Apr 4;285(13):1736-45
references.pmid: 11277828
references.citation: Am J Transplant. 2012 May;12(5):1268-74
references.pmid: 22300426
references.citation: Br J Cancer. 2013 Jul 9;109(1):280-8
references.pmid: 23756857
references.citation: Br J Cancer. 2003 Oct 6;89(7):1221-7
references.pmid: 14520450
references.citation: J Clin Oncol. 2011 Jul 20;29(21):2897-903
references.pmid: 21690473
references.citation: J Clin Oncol. 2010 Feb 10;28(5):773-9
references.pmid: 20048176
references.citation: Haematologica. 2010 Jul;95(7):1216-20
references.pmid: 20053870
references.citation: Br J Haematol. 2013 Sep;162(5):708-10
references.pmid: 23692259
references.citation: Liver Transpl. 2008 Feb;14(2):144-50
references.pmid: 18236386
references.citation: Cancer. 1999 Sep 15;86(6):1080-6
references.pmid: 10491537
references.citation: Blood. 2004 Aug 1;104(3):822-8
references.pmid: 15090454
references.citation: Cancer. 2012 Oct 1;118(19):4869-76
references.pmid: 22359254
references.citation: Blood. 2003 Jul 1;102(1):43-52
references.pmid: 12623843
references.citation: Mult Scler. 2006 Jun;12(3):363-6
references.pmid: 16764353
references.citation: Am J Hematol. 2011 Feb;86(2):206-9
references.pmid: 21264909
references.citation: J Rheumatol. 2010 Mar;37(3):485-90
references.pmid: 20080917
references.citation: Am J Transplant. 2004;4 Suppl 9:13-26
references.pmid: 15113352
references.citation: Leukemia. 2012 Mar;26(3):422-3
references.pmid: 21869837
references.citation: JAMA. 2011 Nov 2;306(17):1891-901
references.pmid: 22045767
references.citation: Nat Rev Cancer. 2008 Jan;8(1):24-36
references.pmid: 18097462
references.citation: Blood. 2013 Jul 11;122(2):294-5
references.pmid: 23847188
references.citation: Transplantation. 2005 Jan 27;79(2):244-7
references.pmid: 15665775
references.citation: Am J Hematol. 2012 Feb;87(2):175-82
references.pmid: 22076943