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Increased risk for lymphoid and myeloid neoplasms in elderly solid-organ transplant recipients.

AbstractBACKGROUND:
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 solid-organ transplant.
AuthorsScott C Quinlan, Lindsay M Morton, Ruth M Pfeiffer, Lesley A Anderson, Ola Landgren, Joan L Warren, Eric A Engels
JournalCancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology (Cancer Epidemiol Biomarkers Prev) Vol. 19 Issue 5 Pg. 1229-37 (May 2010) ISSN: 1538-7755 [Electronic] United States
PMID20406959 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Intramural)
CopyrightCopyright (c) 2010 AACR
Topics
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Female
  • Hodgkin Disease (etiology, pathology)
  • Humans
  • Lymphoma, Non-Hodgkin (etiology, pathology)
  • Male
  • Neoplasms, Plasma Cell (etiology, pathology)
  • Organ Transplantation (adverse effects)
  • Risk Factors
  • SEER Program

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