Outcomes of patients with a pretransplant history of early-stage melanoma

Puza, Charles J.; Barbas, Andrew S.; Mosca, Paul J.

doi:10.1097/cmr.0000000000000471

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…For example, a study of 12 patients with a pretransplant history of early‐stage melanoma and a median period between melanoma diagnosis and organ transplantation of 4.1 years found that two of these patients had developed new melanoma lesions after a median 5.3 years, with these lesions regarded as de novo tumors . Both of these patients were successfully treated by wide local excision . By contrast, we could not identify any study regarding the management of EHM diagnosed shortly before LDLT.…”

Section: Discussionmentioning

confidence: 80%

“…Few studies have evaluated post‐transplant outcomes in patients with a pretransplant history of EHM . For example, a study of 12 patients with a pretransplant history of early‐stage melanoma and a median period between melanoma diagnosis and organ transplantation of 4.1 years found that two of these patients had developed new melanoma lesions after a median 5.3 years, with these lesions regarded as de novo tumors . Both of these patients were successfully treated by wide local excision .…”

Section: Discussionmentioning

confidence: 99%

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Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

Park

Hwang

Song

et al. 2020

J Hepato Biliary Pancreat

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Background: This study analyzed treatment and outcomes in patients with primary extrahepatic malignancy (EHM) incidentally diagnosed during pretransplant evaluation for living donor liver transplantation (LDLT). Methods: Of 4621 adult patients undergoing LDLT over 19 years, 41 were diagnosed with EHM shortly before LDLT (incidental malignancy group), and 92 had been treated for EHM more than 6 months before LDLT (treated malignancy group). Results: Most common EHMs were colorectal, thyroid, and stomach cancers in the incidental malignancy group; and stomach, breast, thyroid, colorectal, and renal cell cancers and lymphoma in the treated malignancy group. Mean interval between EHM diagnosis and LDLT in the incidental malignancy group was 1.5 ± 1.6 months. Of the 41 patients in this group, 15 (35.6%), seven (17.1%), and 16 (39.0%) underwent EHM treatment before, during, and after LDLT, respectively, whereas three (7.3%) underwent observation alone.During a mean follow-up of 70.1 ± 50.8 months, six (14.6%) patients showed tumor recurrence, and three (7.3%) died of tumor progression. All recurrences developed in patients with tumor stages higher than the earliest stage. The mean interval between EHM diagnosis and LDLT in treated malignancy group was 79.8 ± 79.6 months. During a mean follow-up of 63.2 ± 54.1 months, three (3.3%) patients showed tumor recurrence and one (1.1%) died of tumor progression. The incidence of EHM recurrence was significantly higher (P = .025), and the overall post-transplant patient survival rate was significantly lower (P = .046), in the incidental malignancy than in the treated malignancy group. Conclusions: Only patients with earliest-stage EHM detected shortly before LDLT are indicated for upfront LDLT combined with peritransplant EHM treatment. K E Y W O R D Shepatocellular carcinoma, living donor liver transplantation, malignancy, recurrence, surveillance

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

Park

Hwang

Song

et al. 2020

J Hepato Biliary Pancreat

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“…Only five studies reporting recurrent melanomas indicated that these were metastases, 37,40–42,52 two studies 53,54 specified that the post‐transplant lesion occurred at the same anatomical site as the pre‐transplantation melanoma and the remaining eight studies, seven of them registry‐based, did not indicate whether the post‐transplantation melanoma was a recurrent tumor or a de novo melanoma. Of the four studies stating that the post‐transplantation melanomas were new lesions, two 55,56 specified that the tumors were in different anatomical locations from the pre‐transplantation primary lesions and two 32,50 did not specify how they determined that the lesions were new melanomas. To summarize the patient‐level data; nine patients had recurrences of the same lesion, four had metastases and 59 were unspecified melanoma “recurrences.” Three patients’ lesions were new, developing at a different anatomical site relative to the primary, and 13 were designated as new but not further detailed.…”

Section: Resultsmentioning

confidence: 99%

Organ transplantation and outcomes in patients with a past history of melanoma: A systematic review and meta‐analysis

Williams

Webster

Thompson

2021

Clinical Transplantation

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Background The incidence of melanoma is steadily rising around the world. There is uncertainty about the safety of solid organ transplantation in patients with a prior history of melanoma. Aim To review studies reporting patients with a history of melanoma before solid organ transplantation. Methods Electronic searches of Medline, Embase, and the Cochrane library up to March 2020. All study designs, in any language and without sample size restriction, were eligible for inclusion. Risk of bias was assessed using established tools, and meta‐analysis was performed using a random‐effects model. Results We identified 41 studies reporting 703 100 transplant recipients and 1692 had pre‐transplantation melanomas. Risk of death, expressed as a hazard ratio, in patients with pre‐transplantation melanoma relative to those without prior melanoma, was 1.32 (95% CI: 1.09–1.59). After transplantation, 13.1% of patients with pre‐transplantation melanoma developed new or recurrent melanoma (IQR: 4.8%–18.2%). Conclusions Around 1‐in‐400 transplant recipients had a prior history of melanoma. This was associated with a greater than 1‐in‐10 risk of new or recurrent melanoma after transplantation and an increased risk of death. A 5‐year waiting time between a melanoma diagnosis and transplantation has been recommended based on historic registry data, but very little additional information is available to justify or revise this.

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“…Six patients died of melanoma, but their initial staging was not available. Between 2008 and 2018, four reviews with precise staging data studied pretransplant melanoma [5,8,11,12]. A summary of these studies is presented in Table 3.…”

Section: Discussionmentioning

confidence: 99%

“…There are a few series of OTR with pretransplant melanoma, either registry studies with many missing data concerning the melanoma, and a few series with complete data but very small patient sample size [5,8–13]. Therefore, these studies cannot provide reliable recommendations concerning the waiting time after melanoma diagnosis, according to the AJCC staging (American Joint Committee on Cancer) [4], after which SOT could be considered safe.…”

Section: Introductionmentioning

confidence: 99%

Outcome of pretransplant melanoma after solid organ transplantation: an observational study

et al. 2021

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Summary The number of patients with a history of melanoma who are awaiting a solid organ transplantation (SOT) is increasing. Few recommendations exist on the timing to transplantation after melanoma diagnosis. The aim of this study was to assess the melanoma recurrence‐free survival after pretransplant melanoma (PTM). We conducted a multicenter ambispective observational study. Organ transplant recipients (OTR) with a history of PTM and complete AJCC staging were included. Thirty‐seven patients (predominantly men with a renal allograft) were included. Five melanomas were in situ, 21 stage IA, 4 stage IB, 5 stage II, and 2 stage IIIB. The median post‐transplantation follow‐up time was 4 years. Sixty‐two percent of patients were followed up more than 2 years. Recurrence‐free survival since melanoma reached 89.9%, but varied significantly according to AJCC staging (P = 0.0129). Three patients presented a recurrence. Despite the rather limited sample size and a wide range of follow‐up, our findings concerning the recurrence‐free survival appear reassuring for in situ and stage IA PTM; accordingly, we suggest that a waiting time to transplantation is not mandatory in patients with in situ or stage IA PTM, especially whenever SOT is urgently needed. Caution is, however, needed for patients with higher stage.

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Outcomes of patients with a pretransplant history of early-stage melanoma

Cited by 6 publications

References 20 publications

Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

Organ transplantation and outcomes in patients with a past history of melanoma: A systematic review and meta‐analysis

Outcome of pretransplant melanoma after solid organ transplantation: an observational study

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