Cutaneous Melanoma Is Related to Immune Suppression in Kidney Transplant Recipients

Vajdic, Claire M.; Leeuwen, Marina T. van; Webster, Angela C; McCredie, Margaret; Stewart, John H.; Chapman, Jeremy R.; Amin, Janaki; McDonald, S.; Grulich, Andrew E.

doi:10.1158/1055-9965.epi-09-0278

Cited by 67 publications

(61 citation statements)

References 45 publications

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“…6 Other factors found to correlate with increased risk of melanoma included use of T lymphocyte-depleting antibodies and excessive UV radiation exposure. 27 These findings are supported by other studies, which note the fading of nevi after transplant failure and termination of immunosuppression. 54 In conclusion, from the research performed to date, it appears that OTRs who subsequently have melanoma have worse overall survival.…”

Section: Clinical Course Of Melanoma In Solid Organ Transplant Recipisupporting

confidence: 73%

“…27 By comparison, lymphoproliferative malignant neoplasms are associated with an innate and inherent immunosuppression characteristic of the disease itself that can be further exacerbated with medications. 55,56 In addition, long-term immunosuppression is a risk factor for both melanoma and lymphoma, namely NHL, which creates an interesting spectrum of possibilities.…”

Section: Molecular Mechanisms and Genetics Of Lymphoma And Melanomamentioning

confidence: 99%

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Melanoma in immunosuppressed patients

Brewer

2010

Expert Review of Dermatology

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The immunogenic characteristics of malignant melanoma are intriguing. To date, multiple studies exist regarding the immunogenicity of melanoma. In this article, we summarize data in the literature on the role of immunosuppression in melanoma and discuss several immunocompromised patient populations in detail. A comprehensive PubMed search was conducted with no date limitation. The following search terms were used: melanoma in combination with immunosuppression, immunocompromised, genetics, antigen processing, UV radiation, organ transplantation, organ transplant recipients, lymphoproliferative disease, lymphoma, CLL, NHL, radiation, and HIV/AIDS. Although no formal criteria were used for inclusion of studies, most pertinent studies on the topic were reviewed, with the exception of smaller case reports and case series. The included studies were generally large (Ն1000 patients in organ transplant recipient studies; Ն500 patients in lymphoma studies), with a focus on institutional experiences, or population-based national or international epidemiologic studies. Melanoma-induced immunosuppression, the role of UV radiation in melanoma development, and the epidemiology, clinical course, and prognosis of melanoma in immunocompromised patients are highlighted. Organ transplant recipients, patients with lymphoproliferative disorders, patients with iatrogenic immunosuppression, and patients with human immunodeficiency virus infection/AIDS are also highlighted. Recommendations are proposed for the care and monitoring of immunosuppressed patients with melanoma. With better understanding of the molecular microenvironment and clinical course of melanoma in immunosuppressed patients, novel therapies could be developed and outcomes potentially affected in these patients.

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Section: Clinical Course Of Melanoma In Solid Organ Transplant Recipisupporting

confidence: 73%

Section: Molecular Mechanisms and Genetics Of Lymphoma And Melanomamentioning

confidence: 99%

Melanoma in immunosuppressed patients

Brewer

2010

Expert Review of Dermatology

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“…NHL risk was significantly elevated within 1 year of HCT, but not thereafter. Three cancers were increased in risk only during certain time intervals from HCT; (5), rectum carcinoma (1), choriocarinoma (6), desmoid small cell tumour (2), ependymoma (2), esthesioneuroblastoma (1), germ cell tumour-unknown primary (7), germ cell tumourextragonadal (6), hepatoblastoma (1), intracranial germ cell tumour (4), lung carcinoma (12), mediastinum germ cell tumour (13), medulloblastoma (16), melanoma (1), merkel cell carcinoma (1), mixed germ cell tumour (1), mixed germ cell tumour-testis (15), myoepithelial sarcoma (1), nasopharyngeal carcinoma (1), neuroblastoma (5), neuroendocrine tumour (3), osteosarcoma (15), ovarian carcinoma (29), ovarian germ cell tumour (6), primitive neuroectodermal tumour (7), paragaglioma (1), pinealoblastoma (3), pulmonary germ cell tumour (1), rhabdomyosarcoma (27), seminoma (15), small cell tumour (4), soft tissue sarcoma (18), synovial sarcoma (2), teratoma (2), testicular germ cell tumour (13), thymic cancer (2), undifferentiated solid malignancy (1) and Wilm's tumour (3). c Other myeloid malignancies include: acute biphenotypic leukaemia (4), myelodysplasia (14) and chronic myelofibrosis (4).…”

Section: Cumulative Incidencementioning

confidence: 99%

“…26 In our study, melanoma risk was elevated in patients transplanted for NHL or MM, but only during the first 4 post transplant years, similar to the pattern over time after kidney transplantation. 27 The risk factors for melanoma were older age and male sex, characteristics that predict melanoma risk in the general population, 28 and correlates of higher cumulative sun exposure. Immune dysregulation during prior chemotherapy and HCT may underlie the increased risk of this immunogenic neoplasm, a hypothesis that is supported by excess acquired melanocytic naevi in immune suppressed patients including chemotherapy recipients.…”

Section: Second Cancers After Autologous Hct Ia Bilmon Et Almentioning

confidence: 99%

Second cancer risk in adults receiving autologous haematopoietic SCT for cancer: a population-based cohort study

Marsney

Daniels

Ashton

et al. 2014

Bone Marrow Transplant

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, CM Vajdic 5 and CAST study group 6 Population-based evidence on second cancer risk following autologous haematopoietic SCT (HCT) is lacking. We quantified second cancer risk for a national, population-based cohort of adult Australians receiving autologous HCT for cancer and notified to the Australasian Bone Marrow Transplant Recipient Registry 1992Registry -2007. Cancer diagnoses and deaths were ascertained by linkage with the Australian Cancer Database and National Death Index. Standardized incidence ratios (SIRs) were calculated and Cox regression models were used to estimate within-cohort risk factors treating death as a competing risk. During a median 2.5 years follow-up, second cancer risk was modestly increased compared with the general population (SIR 1.4, 95% confidence interval 1.2-1.6); significantly elevated risk was also observed for AML/myelodysplastic syndrome (SIR ¼ 20.6), melanoma (SIR ¼ 2.6) and non-Hodgkin lymphoma (SIR ¼ 3.3). Recipients at elevated risk of any second cancer included males, and those transplanted at a younger age, in an earlier HCT era, or for lymphoma or testicular cancer. Male sex, older age (445 years) and history of relapse after HCT predicted melanoma risk. Transplantation for Hodgkin lymphoma and older age were associated with lung cancer risk. Second malignancies are an important late effect and these results inform and emphasize the need for cancer surveillance in autologous HCT survivors.Bone Marrow Transplantation (2014) 49, 691-698; doi:10.1038/bmt.2014.13; published online 17 February 2014Keywords: autologous transplantation; outcomes; risk; surveillance INTRODUCTION Autologous haematopoietic SCT (HCT) is increasingly being used in Australia and elsewhere as a therapy for several haematopoietic and solid organ malignancies. 1,2 Life expectancy following HCT has also improved, 3 increasing the number of HCT survivors globally. Characterizing late effects and identifying those at risk will maximize the long-term health of HCT recipients.Second cancers are a recognized late effect of chemo-radiation therapy in general, and in the HCT setting specifically. 4-11 The cumulative incidence of second cancer after autologous HCT may be as high as 29% after 15 years, 11 with the greatest excess risk observed for AML and myelodysplastic syndromes (MDSs). 10,[12][13][14][15] Most prior studies have examined second cancer risk in recipients of allogeneic and autologous HCT, with the largest based on international transplant registry cohorts. 9 Furthermore, most studies ascertained second cancers from hospital records or by self-report, potentially under-estimating risk. There are no population-based estimates of the risk of secondary cancer in adult recipients of autologous HCT. We examined the incidence and risk factors for second cancer in a national, population-based cohort of 7765 adult Australian autologous HCT recipients, 1992HCT recipients, -2007

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“…3,4 Cancer incidence across intervals of kidney function and failure has been assessed only in one Australian study. 5 However, due to sample size limitations, this study did not provide precise estimates for many individual cancers, and except for melanoma and lip cancer, 6,7 did not address whether cancer incidence changed over multiple intervals.…”

mentioning

confidence: 99%

Variation in Cancer Incidence among Patients with ESRD during Kidney Function and Nonfunction Intervals

Yanik

Clarke

Snyder

et al. 2015

JASN

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Among patients with ESRD, cancer risk is affected by kidney dysfunction and by immunosuppression after transplant. Assessing patterns across periods of dialysis and kidney transplantation may inform cancer etiology. We evaluated 202,195 kidney transplant candidates and recipients from a linkage between the Scientific Registry of Transplant Recipients and cancer registries, and compared incidence in kidney function intervals (time with a transplant) with incidence in nonfunction intervals (waitlist or time after transplant failure), adjusting for demographic factors. Incidence of infection-related and immune-related cancer was higher during kidney function intervals than during nonfunction intervals. Incidence was most elevated for Kaposi sarcoma (hazard ratio [HR], 9.1; 95% confidence interval (95% CI), 4.7 to 18), nonHodgkin's lymphoma (HR, 3.2; 95% CI, 2.8 to 3.7), Hodgkin's lymphoma (HR, 3.0; 95% CI, 1.7 to 5.3), lip cancer (HR, 3.4; 95% CI, 2.0 to 6.0), and nonepithelial skin cancers (HR, 3.8; 95% CI, 2.5 to 5.8). Conversely, ESRD-related cancer incidence was lower during kidney function intervals (kidney cancer: HR, 0.8; 95% CI, 0.7 to 0.8 and thyroid cancer: HR, 0.7; 95% CI, 0.6 to 0.8). With each successive interval, incidence changed in alternating directions for non-Hodgkin's lymphoma, melanoma, and lung, pancreatic, and nonepithelial skin cancers (higher during function intervals), and kidney and thyroid cancers (higher during nonfunction intervals). For many cancers, incidence remained higher than in the general population across all intervals. These data indicate strong short-term effects of kidney dysfunction and immunosuppression on cancer incidence in patients with ESRD, suggesting a need for persistent cancer screening and prevention.

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Cutaneous Melanoma Is Related to Immune Suppression in Kidney Transplant Recipients

Cited by 67 publications

References 45 publications

Melanoma in immunosuppressed patients

Melanoma in immunosuppressed patients

Second cancer risk in adults receiving autologous haematopoietic SCT for cancer: a population-based cohort study

Variation in Cancer Incidence among Patients with ESRD during Kidney Function and Nonfunction Intervals

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