Risk of myeloid neoplasms after solid organ transplantation

Area of Science:

• Transplantation immunology
• Hematologic oncology
• Cancer epidemiology

Background:

• Solid organ transplant recipients have increased cancer risks due to immunosuppression.
• Risks for hematologic malignancies of myeloid origin in these patients are not well understood.

Purpose of the Study:

• To investigate the risks of myeloid neoplasms in solid organ transplant recipients.
• To examine survival outcomes for these patients.

Main Methods:

• Linked US Scientific Registry of Transplant Recipients with 15 population-based cancer registries.
• Analyzed cancer occurrence among 207,859 solid organ transplants from 1987-2009.
• Calculated standardized incidence ratios (SIRs) and used Poisson regression and log-rank tests.

Main Results:

• Significantly elevated risks for myelodysplastic syndromes (SIR 4.6), acute myeloid leukemia (SIR 2.7), chronic myeloid leukemia (SIR 2.3), and polycythemia vera (SIR 7.2).
• Highest risks observed in younger individuals, varying by time since transplantation and organ type.
• Azathioprine use increased risk for myelodysplastic syndromes and acute myeloid leukemia.
• Overall survival following acute myeloid leukemia/myelodysplastic syndromes was inferior compared to the general population.

Conclusions:

• Increased risks for specific myeloid neoplasms post-solid organ transplantation suggest a role for immune dysfunction in their etiology.
• Heightened clinician awareness of myeloid neoplasms is crucial during transplant recipient follow-up due to increased risks and inferior survival.