De novo malignancy after paediatric renal replacement therapy

Abstract

Aims-To determine frequency, type, determinants, and outcome of malignancies in children with end stage renal failure. Methods-All Dutch patients, aged less than 15 years, who started chronic renal replacement therapy between 1972 and 1992 and who were at least 18 years old on 1 January 1997, were retrospectively studied. Results-Mean follow up from first renal replacement therapy was 15.5 years. Twenty two malignancies were found in 21 of 249 patients. Skin cancer accounted for 59% and non-Hodgkin lymphoma for 23% of malignancies. At 25 years after first renal replacement therapy, the probability of developing a malignancy was 17% (95% CI: 9 to 24%). Compared to the general population the incidence rate for overall cancer was tenfold higher. For nonmelanoma skin cancer and non-Hodgkin lymphoma, standardised risks were 222 and 46 respectively. The use of more than 20 mg/kg cyclophosphamide showed an association with increased risk of malignancy. Six patients died as a result of their malignancy, accounting for 9.5% of overall mortality. Whereas four out of five patients with non-Hodgkin lymphoma died, the most frequent malignancy, skin cancer, did not contribute to mortality. Conclusion-The long term risk of certain malignancies is significantly increased in children who have undergone renal replacement therapy. As an important contributor to overall mortality, awareness of this risk of malignancy in these patients is necessary, especially after treatment with cyclophosphamide. (Arch Dis Child 2001;85:478-483) Keywords: renal replacement therapy; malignancy; follow up The incidence of de novo malignancies in adult recipients of renal transplants is between six and seven times higher than in the general population.1 2 This is thought to be related to the use of immunosuppressive drugs for prevention of graft rejection. Mechanisms through which malignancies can arise include impaired immune surveillance, increased susceptibility to oncogenic viruses, and direct mutagenic eVects of the drugs themselves. [1][2][3] An increased risk of malignancy has also been described in adult dialysis patients: Inamoto et al found this group to have a 1.4-fold increased risk. 4 In adult kidney recipients, post-transplant malignancy is known to be an important cause of morbidity and mortality, with cumulative incidences in long term follow up studies varying from 2.6% to 19.4%.1 2 5-9 Non-melanoma skin cancer is the most frequent malignancy in this group. 1 2 5 6 8 10 11In young adults with renal insuYciency since childhood, malignancy seems to be much less of a problem, with cumulative incidences varying from 0.8% to 3.9% [12][13][14][15] ; lymphoma is the most frequent malignancy.14-16 However, current studies are either based on incomplete data registry or follow up time is relatively short. The long term risk of malignancy in young adults with renal insuYciency since childhood has not been evaluated suYciently.We present data from a Dutch national cohort study on Late EVects of Renal InsuYciency in Children (LERIC). ...

Long-Term Risk of Cancer in Survivors of Pediatric ESRD

“…Patients who needed .3 consecutive months of RRT were considered to receive chronic RRT. In 2000, we conducted the first study on these 249 patients (9). In 2010, the 10-year extension study was performed, covering the period from the last chart review in 2000 to the last chart review in 2010 or the patient's death.…”

“…To this end, LERIC Study coworkers visited all 37 hospitals that had been involved in the medical care of study patients. Data collection of the first period up to 2000 has been described in detail (9). For the second follow-up period, we reviewed the medical charts of all patients between June 1, 2010 and February 1, 2011.…”

“…However, because nearly all studies have been performed in patients receiving kidney transplants in adulthood, few data exist on the occurrence of malignancies in adult patients who have received a renal graft in childhood (3,7,8). In a previous report in 2000, we showed that, in the latter group, the probability of developing a malignancy was 17% (95% confidence interval [95% CI], 9% to 24%) after these children reached an age between 20 and 40 years old (9). This was consistent with a 10 times increase in the incidence of de novo malignancy compared with the general population (GP) (9) that was also found in studies in patients with adult onset of ESRD (3-5,10-12).…”

Long-term outcome of adjuvant chemotherapy cyclophosphamide, mitoxantrone, and fluorouracil in women with breast cancer

“…In the present study, six new skin cancers were found, which has not earlier been reported after adjuvant chemotherapy of breast cancer, because benign skin tumours are not perhaps counted. Coutinho et al [19] and other authors reported that squamous cell carcinomas, basal cell carcinomas of the skin and non-Hodgkin lymphomas are significantly increased after renal replacement therapy. Detecting two meningiomas after adjuvant CNF is surprising.…”

Post-transplant malignancies in pediatric liver transplant recipients: Experience of two centers in Turkey

“…The estimated incidence of de novo malignancy is 20% after 10 years and almost 30% after 20 years of chronic immunosuppression. Death is due to various diseases, such as lymphoma/post-transplant lymphoproliferative disease (PTLD), skin cancers, and various solid organ tumor types (1,(11)(12)(13)(14)(15)(16).…”