Preexisting melanoma and hematological malignancies, prognosis, and timing to solid organ transplantation: A consensus expert opinion statement

Abstract

Patients undergoing evaluation for solid organ transplantation (SOT) frequently have a history of malignancy. Only patients with treated cancer are considered for SOT but the benefits of transplantation need to be balanced against the risk of tumor recurrence, taking into consideration the potential effects of immunosuppression. Prior guidelines on timing to transplant in patients with a prior treated malignancy do not account for current staging, disease biology, or advances in cancer treatments. To update these recommendations, the American Society of Transplantation (AST) facilitated a consensus workshop to comprehensively review contemporary literature regarding cancer therapies, cancer stage specific prognosis, the kinetics of cancer recurrence, as well as the limited data on the effects of immunosuppression on cancer‐specific outcomes. This document contains prognosis, treatment, and transplant recommendations for melanoma and hematological malignancies. Given the limited data regarding the risk of cancer recurrence in transplant recipients, the goal of the AST‐sponsored conference and the consensus documents produced are to provide expert opinion recommendations that help in the evaluation of patients with a history of a pretransplant malignancy for transplant candidacy.

Analysis of malignant melanoma risk and outcomes in solid organ transplant recipients: Assessment of transplant candidacy and the potential role of checkpoint inhibitors

“…This manuscript primarily addresses pretransplant MM, the occurrence, and management of de novo MM post‐transplantation, including the potential emerging role of checkpoint inhibitors in this setting. The authors offer an opinion regarding the risks associated with pretransplant melanoma to support recently published expert opinion for transplant candidacy 1 …”

“…In patients with a pretransplant history of melanoma, MM‐specific outcome data are limited, which present difficulty in establishing guidelines for transplant candidacy 1,5,9,10 …”

“…Based on a review of the current evidence and best practices, a minimum wait time of one year before transplantation has now been recommended by an expert opinion statement from the American Society for Transplantation, Liver and Intestinal Community Practice, for patients with stages IA, IB, and IIA melanoma, 1–2 years for stage IIIA, and 2–4 years for stages IIB, IIC, and IIIB 1 . A more detailed discussion and table to guide transplant providers regarding transplant candidacy for patients with pretransplant melanoma are available in the publication by Al‐Adra et al 1 These recommendations are an update from previous opinion and open the discussion toward the increased use of SLNB for at‐risk groups 1,6,20,21 . Recent NCCN melanoma guidelines recommend consideration of SLNB in patients with T1a lesions < 0.8mm with other adverse features, for example, high mitotic index > 2/mm2, young age, lymphovascular invasion, or a combination of these factors 16 .…”

Balancing uncertain risks in candidates for solid organ transplantation with a history of malignancy: Who is safe to transplant?

“…In this issue of AJT , Al‐Adra et al present recommendations stemming from an expert consensus conference held to address this issue in 2019 1,2 . The authors review recent advancements in cancer genomics and treatments, and provide a brief summary of the outcomes for cancer patients treated according stage‐specific guidelines.…”

Cancer and transplant: A delicate balance

“…In September 2019, the American Society of Transplantation gathered transplant providers and oncologists for a workshop to establish guidelines to determine when transplant candidates with a history of cancer can undergo transplantation. The results are two consensus expert opinion statements (published in this issue): “Pretransplant solid organ malignancy and organ transplant candidacy” and “Preexisting melanoma and hematological malignancies, prognosis, and timing to solid organ transplantation.” 1,2 …”