Risk of lymphoma subtypes after solid organ transplantation in the United States

Abstract

Background:Solid organ transplant recipients have high risk of lymphomas, including non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). A gap in our understanding of post-transplant lymphomas involves the spectrum and associated risks of their many histologic subtypes.Methods:We linked nationwide data on solid organ transplants from the US Scientific Registry of Transplant Recipients (1987–2008) to 14 state and regional cancer registries, yielding 791 281 person-years of follow-up for 19 distinct NHL subtypes and HL. We calculated standardised incidence ratios (SIRs) and used Poisson regression to compare SIRs by recipient age, transplanted organ, and time since transplantation.Results:The risk varied widely across subtypes, with strong elevations (SIRs 10–100) for hepatosplenic T-cell lymphoma, Burkitt's lymphoma, NK/T-cell lymphoma, diffuse large B-cell lymphoma, and anaplastic large-cell lymphoma (both systemic and primary cutaneous forms). Moderate elevations (SIRs 2–4) were observed for HL and lymphoplasmacytic, peripheral T-cell, and marginal zone lymphomas, but SIRs for indolent lymphoma subtypes were not elevated. Generally, SIRs were highest for younger recipients (<20 years) and those receiving organs other than kidneys.Conclusion:Transplant recipients experience markedly elevated risk of a distinct spectrum of lymphoma subtypes. These findings support the aetiologic relevance of immunosuppression for certain subtypes and underscore the importance of detailed haematopathologic workup for transplant recipients with suspected lymphoma.

Hepatitis B or C virus infection and risk of non-Hodgkin lymphoma among solid organ transplant recipients

“…We therefore investigated HBV, HCV, and NHL risk in the Transplant Cancer Match Study (www.transplantmatch.cancer.gov), 12 linking the US Scientific Registry of Transplant Recipients (SRTR) with state/regional population-based cancer registries to provide comprehensive, systematic cancer ascertainment for solid organ transplant recipients. The SRTR collects detailed data on all US solid organ transplants since 1987.…”

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“…1 However, solid-organ transplant patients must receive intensive long-term immunosuppressive therapy to prevent rejection of the transplant, putting them at high risk of developing de novo malignancies and opportunistic infections. In addition, recurrent diseases are some of the main entities leading to late graft loss.…”

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“…[1][2][3] The risk of developing non-Hodgkin lymphoma is increased 6-fold after transplant. 3,4 Burkitt lymphoma is an aggressive B-cell nonHodgkin lymphoma that is endemic in parts of Africa and New Guinea and occurs sporadically in Europe and North America. 1,5 Although endemic and sporadic Burkitt lymphoma are recognized by the World Health Organization as distinct entities, they are indistinguishable on histology.…”

“…There is an increased risk of developing diffuse large B-cell lymphoma and Burkitt lymphoma, the most common subtypes of lymphoma that occur after transplant, in patients aged < 20 years and patients who received liver or thoracic organ transplant. 3 In patients having liver transplant, the risk of developing Burkitt lymphoma may be lower in patients who have noncholestatic cirrhosis and higher in patients who have cholestatic liver disease as the indication for liver transplant. 5 Although most posttransplant lymphoproliferative disorders originate from postgerminal center cells, Burkitt lymphoma has a germinal center molecular profile and has more aggressive behavior than other posttransplant lymphoproliferative disorders.…”