Increased Risk for Lymphoid and Myeloid Neoplasms in Elderly Solid-Organ Transplant Recipients

Abstract

Background: By assessing the spectrum of hematologic malignancies associated with solid-organ transplantation in the elderly, we provide information on the pathogenesis of lymphoid and myeloid neoplasms and the clinical manifestations of immunosuppression.Methods: Using data from the U.S. Surveillance, Epidemiology, and End Results Medicare database, we identified 83,016 cases with a hematologic malignancy (age 66-99 years) and 166,057 population-based controls matched to cases by age, sex, and calendar year. Medicare claims were used to identify a history of solid-organ transplantation. We used polytomous logistic regression to calculate odds ratios (OR) comparing transplantation history among cases with various hematologic malignancy subtypes and controls, adjusting for the matching factors and race.Results: A prior solid-organ transplant was identified in 216 (0.26%) cases and 204 (0.12%) controls. Transplantation was associated with increased risk for non-Hodgkin lymphomas [OR, 2.13; 95% confidence interval (95% CI), 1.67-2.72], especially diffuse large B-cell lymphoma (OR, 3.29; 95% CI, 2.28-4.76), marginal zone lymphoma (OR, 2.48; 95% CI, 1.17-5.22), lymphoplasmacytic lymphoma (OR, 3.32; 95% CI, 1.41-7.81), and T-cell lymphoma (OR, 3.07; 95% CI, 1.56-6.06). Transplantation was also associated with elevated risk of Hodgkin lymphoma (OR, 2.53; 95% CI, 1.01-6.35) and plasma cell neoplasms (OR, 1.91; 95% CI, 1.24-2.93). Risks for myeloid neoplasms were also elevated (OR, 1.99; 95% CI, 1.41-2.81).Conclusion: Solid-organ transplantation is associated with a wide spectrum of hematologic malignancies in the elderly. Risk was increased for four specific non-Hodgkin lymphoma subtypes for which a viral agent has been implicated, supporting an added role for immunosuppression.Impact: Our results support monitoring for a wide spectrum of hematologic malignancies following solidorgan transplant. Cancer Epidemiol Biomarkers Prev; 19(5); 1229-37. ©2010 AACR.

Rationale and Design of the International Lymphoma Epidemiology Consortium (InterLymph) Non-Hodgkin Lymphoma Subtypes Project

“…Additionally, studies have reported that certain infectious agents are associated with risk of specific NHL subtypes, such as human T-cell lymphotropic virus, type I (HTLV-I) with adult T-cell leukemia/lymphoma (15), and Helicobacter pylori with gastric mucosa-associated lymphoid tissue NHL (16), whereas infection with the HIV (17)(18)(19) and hepatitis C virus (20,21) are associated with multiple NHL subtypes. Variation in risk among NHL subtypes also is clearly evident for associations with autoimmune conditions (22), iatrogenic immunodeficiency associated with solid organ transplantation (23)(24)(25), and certain common genetic variants (26)(27)(28)(29)(30)(31). In contrast, cumulative sun exposure appears to affect the risk of all NHL subtypes (32).…”

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“…Risk of non-Hodgkin lymphoma in transplant recipients is 3-to 21-fold higher than the general population and 120-fold higher in children who receive transplants. 3 In our series, most malignancies were categorized as PTLD, which typically occurs with advanced disease and frequent extranodal involvement. 4 Our previous study showed that 33% patients were diagnosed with nodal PTLD.…”

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“…In 2 previous studies that evaluated the risk of non-Hodgkin lymphoma in transplant recipients, there was an increased risk of diffuse large B-cell lymphoma compared with the general population but no increase in follicular lymphoma. 13,14 The risk of lymphoma subtypes may differ by the type of organ transplanted. The risk of developing diffuse large B-cell lymphoma and anaplastic large-cell lymphoma may be greatest in pancreas and in combined kidney and pancreas recipients, but the risk of developing Burkitt lymphoma may be greatest in liver and thoracic organ recipients.…”