Solid Organ Transplantation in Patients With a History of Lymphoma

Abstract

There is an increasing number of long-term survivors of Hodgkin and non-Hodgkin lymphoma. These people may have a need for subsequent solid organ transplantation, often as a result of late effects of their lymphoma treatment. There is abundant literature demonstrating that patients with a history of lymphoma are appropriate candidates for solid organ transplantation. Long-term survival without relapse and with a functioning graft is possible. Patients with a history of post-transplantation lymphoproliferative disorders and patients who have received a prior hematopoietic stem-cell transplantation may also be candidates. Although high-level supporting evidence is not available, most guidelines recommend a waiting period of 2 to 5 years after lymphoma treatment before patients undergo solid organ transplantation. Each patient with a history of lymphoma requires a multidisciplinary approach and should be evaluated on a case-by-case basis before consideration of solid organ transplantation.

A world-wide survey on kidney transplantation practices in breast cancer survivors: The need for new management guidelines

“…12 Traditionally, transplantation is delayed until cancer remission is proven, with most organizations recommending waiting periods of 2-5 years. 3,10 Given the prevalence of cancer in patients deemed ineligible for kidney transplantation, measuring up to 12% in a study of 409 ESRD patients, existing guidelines have the potential to dramatically impact a patient's access to organs. 13 The heterogeneity of breast cancer is now recognized in its distinct molecular profiles, each of which has varying recurrence patterns.…”

“…This is particularly true in the setting of breast cancer, the most common non-skin malignancy in women and a cancer for which personalized medicine is rapidly becoming possible. 10,11 With this new knowledge comes a need to revisit guidelines and determine current practices for transplantation in this setting.…”

“…However, as our understanding of cancer biology increases, so does the ability to more accurately prognosticate recurrence risk and even potentially identify features associated with adverse oncologic outcomes from immunosuppression. This is particularly true in the setting of breast cancer, the most common non‐skin malignancy in women and a cancer for which personalized medicine is rapidly becoming possible 10,11 . With this new knowledge comes a need to revisit guidelines and determine current practices for transplantation in this setting.…”

“…Breast cancer is increasingly prevalent in patients with end stage renal disease (ESRD) undergoing renal transplant evaluation 12 . Traditionally, transplantation is delayed until cancer remission is proven, with most organizations recommending waiting periods of 2–5 years 3,10 . Given the prevalence of cancer in patients deemed ineligible for kidney transplantation, measuring up to 12% in a study of 409 ESRD patients, existing guidelines have the potential to dramatically impact a patient's access to organs 13 .…”

Solid Organ Transplantation in Selected Patients With a History of Lymphoma: Has the Time Come?

“…What we can do is supply the transplant committee with accurate and individual information prognostic for patient survival, as Bierman recommends. In the review, 1 Table 2, which lists current guidelines, is interesting in this regard. Clearly each group is struggling to separate acceptable situations from those that are not.…”