Long-term follow-up of lung and heart transplant recipients with pre-transplant malignancies

Sigurdardottir, Vilborg; Bjørtuft, Øystein; Eiskjær, Hans; Ekmehag, Björn; Gude, Einar; Gustafsson, Finn; Hagerman, Inger; Halme, Maija; Lommi, Jyri; Mared, L.; Riise, Gerdt C.; Simonsen, Svein

doi:10.1016/j.healun.2012.09.007

Cited by 35 publications

(42 citation statements)

References 17 publications

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“…Every PT patient in our study had been considered cured at the time of transplantation, with a mean interval of 8.3 years from diagnosis to transplant, and in fact, relapses were very uncommon. When HT started to be performed in patients with a history of tumors, the average cancer‐free interval before transplantation was almost 10 years ; however, the current arbitrary threshold value for considering cancer cured is 5 years, although it depends on the cancer type . In the study by Bratsttrom et al, 45% of patients had a waiting time ≤5 years, and those patients, as well as those with a waiting time >10 years (29%), had significantly higher cancer‐related mortality than patients with a waiting time of 5–10 years .…”

Section: Discussionmentioning

confidence: 99%

Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History

Delgado

Alonso‐Pulpón

Mirabet

et al. 2016

American Journal of Transplantation

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Neoplasm history increases morbidity and mortality after solid organ transplantation and has disqualified patients from transplantation. Studies are needed to identify factors to be considered when deciding on the suitability of a patient with previous tumor for heart transplantation. A retrospective epidemiological study was conducted in heart transplant (HT) recipients (Spanish Post-Heart Transplant Tumor Registry) comparing the epidemiological data, immunosuppressive treatments and incidence of post-HT tumors between patients with previous malignant noncardiac tumor and with no previous tumor (NPT). The impact of previous tumor (PT) on overall survival (OS) was also assessed. A total of 4561 patients, 77 PT and 4484 NPT, were evaluated. The NPT group had a higher proportion of men than the PT group (p < 0.001). The incidence of post-HT tumors was 1.8 times greater in the PT group (95% confidence interval [CI] 1.2-2.6; p < 0.001), mainly due to the increased risk in patients with a previous hematologic tumor (rate ratio 2.3, 95% CI 1.3-4.0, p < 0.004). OS during the 10-year posttransplant period was significantly lower in the PT than the NPT group (p = 0.048) but similar when the analysis was conducted after a first post-HT tumor was diagnosed. In conclusion, a history of PT increases the incidence of post-HT tumors and should be taken into account when considering a patient for HT.

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Section: Discussionmentioning

confidence: 99%

Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History

Delgado

Alonso‐Pulpón

Mirabet

et al. 2016

American Journal of Transplantation

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“…These guidelines suggest that absolute contraindications include malignancy within the past 2 years, as well as any other end-organ failure (Table 3) [37]. The appropriate time frame in which one can be deemed free of recurrence is matter of expert consensus, although there are reports suggesting that in patients with a history of previous malignancy, the risk of recurrence is greatest within the first year and significantly lower after 5 years [38].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Lung Transplantation after Allogeneic Hematopoietic Stem Cell Transplantation

Cheng

Edelman

Madtes

et al. 2014

Biology of Blood and Marrow Transplantation

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Other than lung transplantation (LT), no specific therapies exist for end-stage lung disease resulting from hematopoietic stem cell transplantation (HCT)-related complications, such as bronchiolitis obliterans syndrome (BOS). We report the indications and outcomes in patients who underwent LT after HCT for hematologic disease from a retrospective case series at our institution and a review of the medical literature. We identified a total of 70 cases of LT after HCT, including 9 allogeneic HCT recipients from our institution who underwent LT between 1990 and 2010. In our cohort, the median age was 16 years (range, 10 to 35 years) at the time of HCT and 34 years (range, 17 to 44 years) at the time of LT, with a median interval between HCT and LT of 10 years (range, 2.9 to 27 years). Indications for LT-included pulmonary fibrosis (n = 4), BOS (n = 3), interstitial pneumonitis related to graft-versus-host disease (GVHD) (n = 1), and primary pulmonary hypertension (n = 1). Median survival was 49 months (range, 2 weeks to 87 months), and 1 patient remains alive at more than 3 years after LT. Survival at 1 year and 5 years after LT was 89% and 37%, respectively. In the medical literature between 1992 and July 2013, we identified 20 articles describing 61 cases of LT after HCT from various centers in the United States, Europe, and Asia. Twenty-six of the 61 cases (43%) involved patients age <18 years at the time of LT. BOS and GVHD of the lung were cited as the indication for LT in the majority of cases (80%; n = 49), followed by pulmonary fibrosis and interstitial lung disease (20%; n = 12). In publications reporting 3 or more cases with a follow-up interval ranging from the immediate postoperative period to 16 years, the survival rate was 71% (39 of 55). Most deaths were attributed to long-term complications of the lung allograft, including infections and BOS. Two deaths were related to recurrent or relapsed hematologic malignancy. LT can prolong survival in some patients who suffer from end-stage pulmonary complications after HCT. Patient factors that likely improve the chances of a good long-term outcome include young age, at least 2 years post-HCT free of relapse from the original hematologic malignancy, and lack of other end-organ dysfunction or manifestations of chronic GVHD that require treatment with immunosuppressive agents.

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“…Post‐transplant immunosuppression also poses a risk of malignancy recurrence, which is related to the duration of cancer‐free survival before organ transplantation . Therefore, past cancer does not necessarily preclude access to cardiac transplantation, possibly bridged by mechanical support .…”

Section: Challenges In Heart Failure Treatment After a Diagnosis Of Cmentioning

confidence: 99%

Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge

Ameri

Canepa

Anker

et al. 2018

European J of Heart Fail

152

137

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Cancer and heart failure (HF) are common medical conditions with a steadily rising prevalence in industrialized countries, particularly in the elderly, and they both potentially carry a poor prognosis. A new diagnosis of malignancy in subjects with pre-existing HF is not infrequent, and challenges HF specialists as well as oncologists with complex questions relating to both HF and cancer management. An increased incidence of cancer in patients with established HF has also been suggested. This review paper summarizes the epidemiology and the prognostic implications of cancer occurrence in HF, the impact of pre-existing HF on cancer treatment decisions and the impact of cancer on HF therapeutic options, while providing some practical suggestions regarding patient care and highlighting gaps in knowledge.

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Long-term follow-up of lung and heart transplant recipients with pre-transplant malignancies

Cited by 35 publications

References 17 publications

Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History

Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History

Outcomes of Lung Transplantation after Allogeneic Hematopoietic Stem Cell Transplantation

Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge

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