Risk of myeloid neoplasms after solid organ transplantation

L M Morton; T M Gibson; C A Clarke; C F Lynch; L A Anderson; R Pfeiffer; O Landgren; D D Weisenburger; E A Engels

doi:10.1038/leu.2014.132

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Risk of myeloid neoplasms after solid organ transplantation

Journal article

Open access

Peer reviewed

Risk of myeloid neoplasms after solid organ transplantation

L M Morton, T M Gibson, C A Clarke, C F Lynch, L A Anderson, R Pfeiffer, O Landgren, D D Weisenburger and E A Engels

Leukemia, Vol.28(12), pp.2317-2323

12/2014

DOI: 10.1038/leu.2014.132

PMCID: PMC4197126

PMID: 24727673

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Abstract

Solid organ transplant recipients have elevated cancer risks, owing in part to pharmacologic immunosuppression. However, little is known about risks for hematologic malignancies of myeloid origin. We linked the US Scientific Registry of Transplant Recipients with 15 population-based cancer registries to ascertain cancer occurrence among 207 859 solid organ transplants (1987-2009). Solid organ transplant recipients had a significantly elevated risk for myeloid neoplasms, with standardized incidence ratios (SIRs) of 4.6 (95% confidence interval 3.8-5.6; N=101) for myelodysplastic syndromes (MDS), 2.7 (2.2-3.2; N=125) for acute myeloid leukemia (AML), 2.3 (1.6-3.2; N=36) for chronic myeloid leukemia and 7.2 (5.4-9.3; N=57) for polycythemia vera. SIRs were highest among younger individuals and varied by time since transplantation and organ type (Poisson regression P<0.05 for all comparisons). Azathioprine for initial maintenance immunosuppression increased risk for MDS (P=0.0002) and AML (2-5 years after transplantation, P=0.0163). Overall survival following AML/MDS among transplant recipients was inferior to that of similar patients reported to US cancer registries (log-rank P<0.0001). Our novel finding of increased risks for specific myeloid neoplasms after solid organ transplantation supports a role for immune dysfunction in myeloid neoplasm etiology. The increased risks and inferior survival should heighten clinician awareness of myeloid neoplasms during follow-up of transplant recipients.

Registries

Leukemia, Myeloid - epidemiology

United States - epidemiology

Humans

Middle Aged

Mortality

Child, Preschool

Infant

Male

Risk

Incidence

Young Adult

Leukemia, Myeloid - etiology

Organ Transplantation - adverse effects

Adolescent

Aged, 80 and over

Adult

Female

Aged

Child

Infant, Newborn

Leukemia, Myeloid - diagnosis

Details

Title: Subtitle: Risk of myeloid neoplasms after solid organ transplantation
Creators: L M Morton - Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
T M Gibson - Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
C A Clarke - 1] Cancer Prevention Institute of California, Fremont, CA, USA Department of Health Research and Policy, Stanford Cancer Institute, Palo Alto, CA, USA
C F Lynch - Department of Epidemiology, University of Iowa, Iowa City, IA, USA
L A Anderson - Cancer Epidemiology and Health Services Research Group, Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
R Pfeiffer - Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
O Landgren - Multiple Myeloma Section, Metabolism Branch, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
D D Weisenburger - Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
E A Engels - Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
Resource Type: Journal article
Publication Details: Leukemia, Vol.28(12), pp.2317-2323
DOI: 10.1038/leu.2014.132
PMID: 24727673
PMCID: PMC4197126
NLM abbreviation: Leukemia
ISSN: 1476-5551
eISSN: 1476-5551
Publisher: England
Grant note: N01PC35142 / NCI NIH HHS HHSN261201000024C / NCI NIH HHS U58 DP000807 / NCCDPHP CDC HHS U58 DP000824 / NCCDPHP CDC HHS HHSN261201000036C / NCI NIH HHS N01PC54405 / NCI NIH HHS U58 DP000817 / NCCDPHP CDC HHS N01PC35137 / NCI NIH HHS U58 DP000812 / NCCDPHP CDC HHS U58 DP000832 / NCCDPHP CDC HHS HHSN261201000035C / NCI NIH HHS U58 DP000805 / NCCDPHP CDC HHS P30 ES005605 / NIEHS NIH HHS U58 DP000848 / NCCDPHP CDC HHS U58 DP000808 / NCCDPHP CDC HHS HHSN261201000034C / NCI NIH HHS N01PC35139 / NCI NIH HHS P30 CA086862 / NCI NIH HHS HHSN261201000037C / NCI NIH HHS HHSN261201000027C / NCI NIH HHS N01PC35143 / NCI NIH HHS ZIA CP010170-11 / Intramural NIH HHS Z99 CA999999 / Intramural NIH HHS HHSN261201000026C / NCI NIH HHS HHSN261201000035I / NCI NIH HHS
Language: English
Date published: 12/2014
Academic Unit: Epidemiology
Record Identifier: 9983995111802771

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