New concepts and best practices for management of pre- and post-transplantation cancer

Campistol, Josep M.; Cuervas-Mons, Valentín; Manito, Nicolás; Almenar, Luís; Arias, Manuel; Casafont, F.; Castillo, Domingo del; Crespo-Leiro, María G.; Delgado, Juan; Herrero, J.I.; Jara, Paloma; Morales, José; Navarro, Mercedes; Oppenheimer, Federico; Prieto, M.; Pulpón, L. Alonso; Rimola, Antoni; Román, A.; Serón, Daniel; Ussetti, Piedad

doi:10.1016/j.trre.2012.07.001

Cited by 86 publications

(105 citation statements)

References 185 publications

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“…However, when managing a de novo posttransplant malignancy in general, most authors advocate reducing or eliminating calcineurin inhibitors and/or starting an mTOR inhibitor. 19 In the case of Kaposi sarcoma, reducing or eliminating calcineurin inhibitors and adding sirolimus is an effective treatment strategy in renal transplant patients. 20 For our patient, the plan was to reduce his dosage of tacrolimus and add sirolimus.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Blackmon

Rajpara

Patel

et al. 2014

Exp Clin Transplant

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Angiosarcoma is a rare malignant neoplasm of vascular endothelial cells. A majority are primarily in the skin. Angiosarcoma of the head and neck is the most common form, but only constitutes 0.1% of all head and neck malignancies. We present an extraordinary case of a 71 year-old male six months status post orthotopic liver transplant secondary to end stage liver disease from cryptogenic cirrhosis, who presented to the liver clinic with a rapidly growing scalp tumor and hypodense lesions within the liver. Further work-up and biopsies confirmed the first documented case of primary scalp angiosarcoma with metastasis to the liver in an orthotopic liver transplant patient. Case ReportA 71-year-old man with an orthotopic liver transplant 6 months earlier, secondary to end-stage liver disease from cryptogenic cirrhosis, presented to the liver clinic with abdominal distension and worsening ascites. The patient was otherwise asymptomatic and denied having fever, chills, abdominal pain, nausea, vomiting, and diarrhea. For immunosuppression, he had been receiving tacrolimus 2 mg twice daily, with tacrolimus levels between 5 and 8. An ultrasound, followed by a computed tomography scan and magnetic resonance imaging of the abdomen, showed numerous small cystic lesions with peripheral enhancement throughout the liver. These findings led the team to be concerned about liver abscesses (Figure 1). The patient was admitted to the hospital for a further work-up.Piperacillin and tazobactam IV were given as antibiotic therapy, and the patient underwent computed tomography-guided paracentesis, aspiration of cystic fluid, and a core needle liver biopsy. The dermatology department was consulted to evaluate a rapidly enlarging and bleeding scalp lesion, present for 5 weeks. A physical examination revealed a bleeding, firm, indurated nodule on the right temporal scalp, with peripheral purpura and ecchymosis extending down the forehead to the right temple (Figure 2). A satellite skin-colored nodule also was noted posterior to the primary lesion. Biopsy of the primary nodule showed dense, diffuse hemorrhagic proliferation of enlarged pleomorphic, mitotic epithelioid, and spindled CD31+ cells, consistent with the diagnosis of epithelioid angiosarcoma (Figure 3)

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Section: Discussionmentioning

confidence: 99%

Untitled

Blackmon

Rajpara

Patel

et al. 2014

Exp Clin Transplant

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“…One of the most important complications is the development of malignancies. The incidences for several tumors are much higher in transplant recipients when compared to the general population and increase with longer duration of follow-up [1,2]. Tumors in the head and neck area cover about 3.5-15% of all malignancies after transplantation [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…A large part of these head and neck cancers (HNC) are squamous cell carcinomas (SCC) of the lip or oropharynx [6][7][8][9][10][11][12]. The exact mechanism for carcinogenesis under immunosuppression remains unclear, however it is clearly a multifactorial process [2]. Firstly, impaired immunosurveillance in itself can stimulate oncogenesis through independent processes.…”

Section: Introductionmentioning

confidence: 99%

“…Firstly, impaired immunosurveillance in itself can stimulate oncogenesis through independent processes. Secondly, long-term immunosuppression also puts the patient at a higher risk of being infected with an oncovirus like the human papillomavirus (HPV) or Epstein-Barr virus [2,13]. Thirdly the drugs used for immunosuppression could also directly play a role.…”

Section: Introductionmentioning

confidence: 99%

“…This is especially the case for calcineurin inhibitors (CNI) like cyclosporine who potentially promote carcinogenesis through complex pathways involving increased angiogenesis, suppressed apoptosis of damaged cells, DNA damage and altered DNA repair [1][2][3]14]. Other immunosuppressive agents, like MMF (mofetil mycophenolate) and more recently inhibitors of the mammalian target of rapamycin (mTOR), have an antiproliferative activity and might have a more protective effect against some tumor types [1,2]. Finally the impact of more 'classical' etiological factors should not be neglected.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Noncutaneous head and neck cancer in solid organ transplant patients: Single center experience

et al. 2014

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Risk Factors for Melanoma in Renal Transplant Recipients

Ascha

Tanenbaum

et al. 2017

JAMA Dermatol

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IMPORTANCE Melanoma risk factors and incidence in renal transplant recipients can inform decision making for both patients and clinicians. OBJECTIVE To determine risk factors and characteristics of renal transplant recipients who develop melanoma. DESIGN, SETTING, AND PARTICIPANTSThis cohort study of a large national data registry used a cohort of renal transplant recipients from the United States Renal Data System (USRDS) database from the years 2004 through 2012. Differences in baseline characteristics between those who did and did not develop melanoma were examined, and a survival analysis was performed. Patients with renal transplants who received a diagnosis of melanoma according to any inpatient or outpatient claim associated with a billing code for melanoma were included. A history of pretransplant melanoma, previous kidney transplantation, or transplantation after 2012 or before 2004 were exclusion criteria. The data analysis was conducted from 2015 to 2016. EXPOSURE Receipt of a renal transplant. MAIN OUTCOMES AND MEASURES Incidence and risk factors for melanoma. RESULTS Of 105 174 patients (64 151 [60.7%] male; mean [SD] age, 49.6 [15.3] years) who received kidney transplants between 2004 and 2012, 488 (0.4%) had a record of melanoma after transplantation. Significant risk factors for developing melanoma vs not developing melanoma included older age among recipients (mean [SD] age, 60.5 [10.2] vs 49.7 [15.3] years; P < .001) and donors (42.6 [15.0] vs 39.2 [15.1] years; P < .001), male sex (71.5% vs 60.7%; P < .001), recipient (96.1% vs 66.5%; P < .001) and donor (92.4% vs 82.9%; P < .001) white race, less than 4 HLA mismatches (44.9% vs 37.1%; P = .001), living donors (44.7% vs 33.7%; P < .001), and sirolimus (22.3% vs 13.2%; P < .001) and cyclosporine (4.9% vs 3.2%; P = .04) therapy. Risk factors significant on survival analysis included older recipient age (hazard ratio [HR] per year, 1

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New concepts and best practices for management of pre- and post-transplantation cancer

Cited by 86 publications

References 185 publications

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Noncutaneous head and neck cancer in solid organ transplant patients: Single center experience

Risk Factors for Melanoma in Renal Transplant Recipients

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