1
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Zwald FO, Sargen MR, Austin AA, Hsieh MC, Pawlish K, Li J, Lynch CF, Yu KJ, Engels EA. Outcomes in solid organ transplant recipients with a pretransplant diagnosis of melanoma. Am J Transplant 2024; 24:993-1002. [PMID: 38387619 PMCID: PMC11144558 DOI: 10.1016/j.ajt.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
Melanoma causes significant morbidity in solid organ transplant recipients (SOTRs). Melanomas diagnosed before transplantation can recur with intensive immunosuppression, but outcomes have not been well studied. We evaluated 901 non-Hispanic White SOTRs with a pretransplant melanoma identified using linked transplant and cancer registry data in the United States. Most pretransplant melanomas were invasive (60.7%), and the median time from diagnosis to transplantation was 5.1 years. After transplantation, 41 SOTRs developed a new invasive melanoma, corresponding to 9-fold increased risk compared with the general population (standardized incidence ratio, 9.2; 95% confidence interval [CI], 6.6-12). Twenty-two SOTRs died from melanoma after transplantation, corresponding to 52-fold increased risk (standardized mortality ratio, 52; 95% CI, 33-79). Risk factors for posttransplant melanoma included age at transplantation (adjusted hazard ratio [HR], 2.86; 95% CI, 1.24-6.60; for age 55+ vs <55 years) and maintenance immunosuppression with cyclosporine/azathioprine (adjusted HR, 2.53; 95% CI, 1.08-5.90). Melanoma mortality was strongly elevated after a posttransplant melanoma diagnosis (HR, 35.6; 95% CI, 14.0-90.4; adjusted for cyclosporine/azathioprine maintenance therapy and calendar year of transplantation). In conclusion, SOTRs with a pretransplant melanoma are at risk of adverse melanoma-related outcomes after transplantation. These findings support thorough dermatologic evaluation prior to transplantation and frequent posttransplant surveillance.
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Affiliation(s)
- Fiona O Zwald
- Department of Dermatology, University of Colorado, Aurora, Colorado, USA
| | - Michael R Sargen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | | | - Mei-Chin Hsieh
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Karen Pawlish
- New Jersey Department of Health, New Jersey State Cancer Registry, Trenton, New Jersey, USA
| | - Jie Li
- New Jersey Department of Health, New Jersey State Cancer Registry, Trenton, New Jersey, USA
| | - Charles F Lynch
- Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Kelly J Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
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2
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Watt KD, Rolak S, Foley DP, Plichta JK, Pruthi S, Farr D, Zwald FO, Carvajal RD, Dudek AZ, Sanger CB, Rocco R, Chang GJ, Dizon DS, Langstraat CL, Teoh D, Agarwal PK, Al-Qaoud T, Eggener S, Kennedy CC, D'Cunha J, Mohindra NA, Stewart S, Habermann TH, Schuster S, Lunning M, Shah NN, Gertz MA, Mehta J, Suvannasankha A, Verna E, Farr M, Blosser CD, Hammel L, Al-Adra DP. Cancer Surveillance in Solid Organ Transplant Recipients With a Pretransplant History of Malignancy: Multidisciplinary Collaborative Expert Opinion. Transplantation 2024:00007890-990000000-00757. [PMID: 38771067 DOI: 10.1097/tp.0000000000005056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
With improved medical treatments, the prognosis for many malignancies has improved, and more patients are presenting for transplant evaluation with a history of treated cancer. Solid organ transplant (SOT) recipients with a prior malignancy are at higher risk of posttransplant recurrence or de novo malignancy, and they may require a cancer surveillance program that is individualized to their specific needs. There is a dearth of literature on optimal surveillance strategies specific to SOT recipients. A working group of transplant physicians and cancer-specific specialists met to provide expert opinion recommendations on optimal cancer surveillance after transplantation for patients with a history of malignancy. Surveillance strategies provided are mainly based on general population recurrence risk data, immunosuppression effects, and limited transplant-specific data and should be considered expert opinion based on current knowledge. Prospective studies of cancer-specific surveillance models in SOT recipients should be supported to inform posttransplant management of this high-risk population.
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Affiliation(s)
| | - Stacey Rolak
- Department of Medicine, Mayo Clinic, Rochester, MN
| | - David P Foley
- Department of Surgery, University of Wisconsin, Madison, WI
| | | | | | - Deborah Farr
- Department of Surgery, University of Texas Southwestern, Dallas, TX
| | - Fiona O Zwald
- Department of Dermatology, Colorado University School of Medicine, Aurora, CO
| | - Richard D Carvajal
- Department of Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | | | - Cristina B Sanger
- Department of Surgery, University of Wisconsin, Madison, WI
- Department of Surgery, William S.Middleton Memorial Veteran's Hospital, Madison, WI
| | - Ricciardi Rocco
- Department of Surgery, Massachusetts General Hospital, Boston MA
| | - George J Chang
- Department of Colon and Rectal Surgery, University of Texas, MD Anderson Cancer Center, Dallas, TX
| | - Don S Dizon
- Department of Medicine, Lifespan Cancer Institute and Brown University, Providence, RI
| | | | - Deanna Teoh
- Department of Obstetrics and Gynecology and Women's Health, University of Minnesota, Minneapolis, MN
| | - Piyush K Agarwal
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL
| | - Talal Al-Qaoud
- Department of Surgery, Medstar Georgetown Transplant Institute, Georgetown University Hospital, Washington DC
| | - Scott Eggener
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL
| | | | | | - Nisha A Mohindra
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shelby Stewart
- Department of Thoracic Surgery, University of Maryland, Baltimore, MD
| | | | - Stephen Schuster
- Department of Medicine, Lymphoma Program, Abraham Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Matthew Lunning
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Nirav N Shah
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jayesh Mehta
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Attaya Suvannasankha
- Department of Medicine, Indiana University School of Medicine and Roudebush VAMC, Indianapolis, IN
| | | | - Maryjane Farr
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christopher D Blosser
- Department of Medicine, University of Washington and Seattle Children's Hospital, Seattle WA
| | - Laura Hammel
- Department of Anesthesiology, University of Wisconsin, Madison, WI
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3
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Melhem Y, Khattab S, Al-janabi MH, Saeid H, Ahmad I, Hasan F. Amelanotic melanoma in a kidney transplant patient: a rare case report. Oxf Med Case Reports 2024; 2024:omae035. [PMID: 38680765 PMCID: PMC11049583 DOI: 10.1093/omcr/omae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/04/2024] [Accepted: 03/17/2024] [Indexed: 05/01/2024] Open
Abstract
Immunosuppressed individuals face a significantly elevated risk of developing aggressive cutaneous malignancies, often surpassing the aggressiveness observed in immunocompetent counterparts. Our patient exhibited several risk factors associated with melanoma development in renal recipients, including skin type, sun exposure, and the duration of immunosuppression. The determination of staging holds paramount importance as it directly influences both prognosis and subsequent management. It is crucial to handle suspected lesions with caution in these patients to facilitate early melanoma detection and enhance overall prognosis.
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Affiliation(s)
- Yara Melhem
- Department of Dermatology, Tishreen University Hospital, Lattakia, Syria
| | - Seham Khattab
- Department of Dermatology, Tishreen University Hospital, Lattakia, Syria
| | | | - Hussein Saeid
- Department of Nephrology, Tishreen University Hospital, Lattakia, Syria
| | - Issa Ahmad
- Tishreen University and Al Andulus Private University for Medical Sciences/Faculty of Medicin/Department of Pathology, Tishreen University Hospital, Lattakia, Syria
| | - Fouz Hasan
- Department of Dermatology, Tishreen University Hospital, Lattakia, Syria
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4
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Rosales BM, Hedley J, De La Mata N, Cavazzoni E, Vajdic CM, Thompson JF, Kelly PJ, Wyburn K, Webster AC. Transmission and Non-transmission of Melanoma From Deceased Solid Organ Donors to Transplant Recipients: Risks and Missed Opportunities. Transplantation 2024:00007890-990000000-00676. [PMID: 38419163 DOI: 10.1097/tp.0000000000004961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Biovigilance concerns are in tension with the need to increase organ donation. Cancer transmission risk from donor to recipient may be overestimated, as non-transmission events are rarely reported. We sought to estimate melanoma transmission risk in deceased organ donation and identify missed opportunities for donation in an Australian cohort with high melanoma prevalence. METHODS We used a population-based approach and linked deceased organ donors, transplant recipients, and potential donors forgone, 2010-2018, with the Central Cancer Registry (CCR), 1976-2018. We identified melanomas using ICD-O-3 classification, assessed the probability of transmission, and compared suspected melanoma history in potential donors forgone with melanoma notifications in the CCR. RESULTS There were 9 of 993 donors with melanoma in CCR; 4 in situ low-risk and 5 invasive high-to-unacceptable risk. Four were unrecognized before donation. Of 16 transplant recipients at risk, we found 0 of 14 transmission events (2 recipients had insufficient follow-up). Of 35 of 3588 potential donors forgone for melanoma risk alone, 17 were otherwise suitable for donation; 6 of 35 had no melanoma in CCR, 2 of 35 had in situ melanomas and 9 of 35 had thin invasive melanomas (localized, ≤0.8 mm thickness). CONCLUSIONS Our findings contribute to current evidence that suggests donors with melanomas of low metastatic potential may provide an opportunity to safely increase organ donation and so access to transplantation.
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Affiliation(s)
- Brenda Maria Rosales
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - James Hedley
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Nicole De La Mata
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Elena Cavazzoni
- NSW Health, NSW Organ and Tissue Donation Service, Kogarah, NSW, Australia
| | - Claire M Vajdic
- Faculty of Medicine and Health, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John F Thompson
- Faculty of Medicine and Health, Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney Sydney, NSW, Australia
| | - Patrick J Kelly
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kate Wyburn
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney Sydney, NSW, Australia
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Angela C Webster
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
- Westmead Applied Research Centre, Westmead Hospital, Westmead, NSW, Australia
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5
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Ng WHS, Curchin DJ, McGinn S, Smith SD. Outcomes in organ transplants from donors with melanoma: a systematic review. Int J Dermatol 2023; 62:1121-1130. [PMID: 37537648 DOI: 10.1111/ijd.16797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
Melanoma transmitted through organ transplantation is an increasingly reported event. Immunosuppression increases the risk of melanoma; however, transmission of malignancy from transplanted organs is a distinct etiology of melanoma occurrence. The risk of transmission of melanoma from an organ donor with melanoma has yet to be determined. The authors aimed to investigate this phenomenon by reviewing the outcomes of patients that received organs from donors with melanoma. A systematic literature review was conducted with emphasis on identifying organ donors with known histories of melanoma and reported information regarding recipients of their organs. The databases PubMed, MEDLINE, Embase, and JBI EBP were searched in January 2023. Search terms included "melanoma," terms for solid organs, "donor," "transplant," "transmission," and their variations as well as terms related to temporal relations. Inclusion criteria were articles that stated outcomes in organ recipients from donors that had a diagnosis of melanoma either pretransplant or postmortem. Reference lists of selected articles were hand searched for further studies. A total of 232 articles were identified from the search parameters. After applying inclusion and exclusion criteria, 13 articles were selected. Hand searching the references of these articles yielded four additional articles. Of the 75 organ recipients that received organs from donors with known melanoma, 43 developed melanoma. While a definitive quantitative risk cannot be ascertained based on our review, the numerous reported cases of melanoma in organ recipients from donors that have melanoma should still be considered by clinicians.
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Affiliation(s)
| | - David John Curchin
- The Westmead Clinical School, Sydney Medical School, The University of Sydney, Westmead, NSW, Australia
| | - Stella McGinn
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Saxon D Smith
- ANU Medical School, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
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6
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Berman H, Shimshak S, Reimer D, Brigham T, Hedges MS, Degesys C, Tolaymat L. Skin Cancer in Solid Organ Transplant Recipients: A Review for the Nondermatologist. Mayo Clin Proc 2022; 97:2355-2368. [PMID: 36334939 DOI: 10.1016/j.mayocp.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022]
Abstract
Solid organ transplant recipients (SOTRs) are at increased risk for the development of skin cancer compared with the general population, which requires consistent monitoring and management from a multidisciplinary team. The aim of this review is to provide a comprehensive overview for nondermatologist clinicians, outlining skin cancer diagnosis, treatment pearls, and skin cancer prevention strategies as they relate to SOTRs. A comprehensive search of the literature was conducted through the MEDLINE database with search terms including organ transplantation, transplant recipient, skin cancer, cutaneous neoplasms, management, and therapies. The search was limited to the English language and dates ranging from January 1, 2011, to December 28, 2021. All studies were reviewed for inclusion. Skin cancer will develop in more than half of SOTRs at some point in their life, most often nonmelanoma skin cancer such as basal cell carcinoma or squamous cell carcinoma. Melanoma and rarer cutaneous malignant neoplasms, such as Merkel cell carcinoma and Kaposi sarcoma, are also more frequent among SOTRs. A multidisciplinary effort at skin cancer screening and patient education is invaluable to prevent skin cancer-related morbidity and mortality in this population of patients. Reduction in immunosuppressive medications and surgical intervention are effective therapeutic approaches, and more novel systemic therapies including G protein-coupled receptor inhibitors and immune checkpoint inhibitors are possible options when traditional treatment approaches are not feasible. Checkpoint inhibitor therapy, however, comes with the risk of allograft rejection. With a growing and aging SOTR population, it is essential that SOTRs have support from dermatologists and nondermatologists alike in skin cancer prevention and treatment.
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Affiliation(s)
- Hannah Berman
- Department of Dermatology, Mayo Clinic, Jacksonville, FL
| | | | | | - Tara Brigham
- Mayo Clinic Medical Library, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - Mary S Hedges
- Department of Internal Medicine, Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Leila Tolaymat
- Department of Dermatology, Mayo Clinic, Jacksonville, FL.
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7
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Vela-Patiño S, Salazar MI, Remba-Shapiro I, Peña-Martínez E, Silva-Roman G, Andoneui-Elguera S, Ordoñez-Garcia JDJ, Taniguchi-Ponciano K, Bonifaz L, Aguilar-Flores C, Marrero-Rodríguez D, Mercado M. Neuroendocrine-immune Interface: Interactions of Two Complex Systems in Health and Disease. Arch Med Res 2022; 53:240-251. [DOI: 10.1016/j.arcmed.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/25/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
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8
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De Novo Malignancy After Liver Transplantation: Risk Assessment, Prevention, and Management-Guidelines From the ILTS-SETH Consensus Conference. Transplantation 2022; 106:e30-e45. [PMID: 34905760 DOI: 10.1097/tp.0000000000003998] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
De novo malignancies (DNMs) following liver transplantation (LT) have been reported as 1 of the major causes of late mortality, being the most common cause of death in the second decade after LT. The overall incidence of DNMs is reported to be in the range of 3.1% to 14.4%, and the incidence is 2- to 3-fold higher in transplant recipients than in age- and sex-matched healthy controls. Long-term immunosuppressive therapy, which is the key in maintaining host tolerance and achieving good long-term outcomes, is known to contribute to a higher risk of DNMs. However, the incidence and type of DNM also depends on different risk factors, including patient demographics, cause of the underlying chronic liver disease, behavior (smoking and alcohol abuse), and pre-existing premalignant conditions. The estimated standardized incidence ratio for different DNMs is also variable. The International Liver Transplantation Society-Spanish Society of Liver Transplantation Consensus Conference working group on DNM has summarized and discussed the current available literature on epidemiology, risk factors, management, and survival after DNMs. Recommendations for screening and surveillance for specific tumors, as well as immunosuppression and cancer-specific management in patients with DNM, are summarized.
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9
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Patras M, Decullier E, Lebbé C, Delyon J, Dantal J, Legendre C, Mazloum M, Du Thanh A, Boukari F, Morelon E, Jullien D, Kanitakis J, Ducroux E. Outcome of pretransplant melanoma after solid organ transplantation: an observational study. Transpl Int 2021; 34:2154-2165. [PMID: 34519106 DOI: 10.1111/tri.14109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
The number of patients with a history of melanoma who are awaiting a solid organ transplantation (SOT) is increasing. Few recommendations exist on the timing to transplantation after melanoma diagnosis. The aim of this study was to assess the melanoma recurrence-free survival after pretransplant melanoma (PTM). We conducted a multicenter ambispective observational study. Organ transplant recipients (OTR) with a history of PTM and complete AJCC staging were included. Thirty-seven patients (predominantly men with a renal allograft) were included. Five melanomas were in situ, 21 stage IA, 4 stage IB, 5 stage II, and 2 stage IIIB. The median post-transplantation follow-up time was 4 years. Sixty-two percent of patients were followed up more than 2 years. Recurrence-free survival since melanoma reached 89.9%, but varied significantly according to AJCC staging (P = 0.0129). Three patients presented a recurrence. Despite the rather limited sample size and a wide range of follow-up, our findings concerning the recurrence-free survival appear reassuring for in situ and stage IA PTM; accordingly, we suggest that a waiting time to transplantation is not mandatory in patients with in situ or stage IA PTM, especially whenever SOT is urgently needed. Caution is, however, needed for patients with higher stage.
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Affiliation(s)
| | - Evelyne Decullier
- Service d'Epidémiologie et Recherches Cliniques, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Céleste Lebbé
- AP-HP Dermatology, INSERM U976, Saint Louis Hospital, Université de Paris, Paris, France
| | - Julie Delyon
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Jacques Dantal
- Service de Néphrologie, Hôpital Universitaire de Nantes, Hôtel Dieu, Nantes, France
| | - Christophe Legendre
- Service de Néphrologie et Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Manal Mazloum
- Service de Néphrologie et Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Aurélie Du Thanh
- Service de Dermatologie, Hôpital Universitaire de Montpellier, Montpellier, France
| | - Feriel Boukari
- Service de Dermatologie, Hôpital Universitaire de Nice, Nice, France
| | - Emmanuel Morelon
- Service de Néphrologie, Hôpital Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Denis Jullien
- Service de Dermatologie, Hôpital Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean Kanitakis
- Service de Dermatologie, Hôpital Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Emilie Ducroux
- Service de Dermatologie, Hôpital Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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10
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Robinson C, Chanchlani R, Kitchlu A. Malignancies after pediatric solid organ transplantation. Pediatr Nephrol 2021; 36:2279-2291. [PMID: 33057766 DOI: 10.1007/s00467-020-04790-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 09/18/2020] [Indexed: 12/19/2022]
Abstract
As life expectancy among pediatric solid organ transplant recipients (SOTRs) improves, the risk of comorbid conditions such as malignancy post-transplantation has also increased. SOTRs are at elevated risks of post-transplantation lymphoproliferative disorders (PTLDs), and skin and solid cancers. PTLDs typically occur early following transplantation, while skin and solid cancers frequently arise in young adulthood (25-40 years). By 30 years following transplantation, 26-41% of pediatric SOTRs have developed cancer. Different risk factors exist for PTLD, and skin and solid cancers, which are modified by cumulative immunosuppression, infections, transplanted organ, and the underlying disease process associated with initial organ failure (e.g., kidney failure). Optimal cancer treatment strategies depend on the specific cancer type, stage, and patient comorbidities. Immunosuppression reduction may be beneficial for certain cancers but must be considered against the risks of acute and chronic rejection and allograft loss. Lifestyle counseling regarding smoking avoidance and sun protection, as well as human papillomavirus vaccination, is an important aspect of cancer prevention. Currently, no cancer screening guidelines exist specifically for pediatric SOTRs. Adult population screening guidelines have not been validated in transplant populations. Therefore, an individualized approach should be taken to cancer screening for pediatric SOTRs, accounting for other cancer risk factors.
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Affiliation(s)
- Cal Robinson
- Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- ICES McMaster, Hamilton, Ontario, Canada
| | - Abhijat Kitchlu
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, 200 Elizabeth Street, 8 Eaton North, 8 N-842, Toronto, Ontario, M5G 2C4, Canada.
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11
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Chayanupatkul M, Gambarin-Gelwan M, Schiano TD. The presence of non-hepatic malignancy and its implication in pursuing liver transplantation. Clin Transplant 2021; 35:e14410. [PMID: 34189778 DOI: 10.1111/ctr.14410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/13/2021] [Accepted: 06/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary extrahepatic malignancy and chronic liver disease co-exist in a considerable number of patients, creating a dilemma both in the aspects of liver transplant candidacy and cancer therapy. In this review, we will explore several aspects and controversies of liver transplantation in patients with non-hepatocellular carcinoma malignancy including risks of cancer recurrence after liver transplantation and the ethical dilemma of the selection of liver transplantation candidates with non-hepatic malignancy. METHODS We performed a search in several online databases and reviewed published articles and ongoing clinical trials in the topics of transplantation and pre-existing malignancies. RESULTS AND DISCUSSION Liver transplantation can be safely performed in selected patients with pre-existing extrahepatic malignancies with low recurrence rate if they have an expected 5-year survival rate of at least 50%. The cancer-free period before transplantation depends on the type, stage, and location of cancer. A shorter or no wait-time may be considered in an early stage cancer or carcinoma in situ. The urgency and benefits of liver transplantation should also be taken into consideration when determining a reasonable wait-time. This is particularly important in patients with decompensated cirrhosis who cannot afford to wait a few years before they can undergo liver transplantation.
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Affiliation(s)
- Maneerat Chayanupatkul
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Maya Gambarin-Gelwan
- Gastroenterology, Hepatology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Thomas D Schiano
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, Recanati-Miller Transplantation Institute, New York, New York, USA
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12
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Zwald F, Carvajal RD, Walker J, Sawinski D, Al-Adra D. Analysis of malignant melanoma risk and outcomes in solid organ transplant recipients: Assessment of transplant candidacy and the potential role of checkpoint inhibitors. Clin Transplant 2021; 35:e14264. [PMID: 33709489 DOI: 10.1111/ctr.14264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/28/2022]
Abstract
Malignant melanoma (MM) causes tremendous morbidity and mortality in the solid organ transplant population and may arise in three different clinical scenarios: (1) pretransplant melanoma; (2) de novo melanoma post transplantation and (3) donor-derived melanoma. This manuscript primarily addresses the first two scenarios with respect to the evaluation and management of pretransplant MM, consideration of transplant candidacy and the occurrence and management of de novo MM post transplantation. The authors outline current evidence describing risks associated with pre-transplant melanoma to support recently established expert opinion for transplant candidacy.
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Affiliation(s)
- Fiona Zwald
- Piedmont Transplant Institute, Atlanta, GA, USA
| | - Richard D Carvajal
- Division of Hematology-Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - John Walker
- Department of Medical Oncology, University of Alberta, Edmonton, AB, Canada
| | - Deirdre Sawinski
- Kidney Pancreas Transplantation, University of Pennsylvania, Philadelphia, PA, USA
| | - David Al-Adra
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
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13
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14
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González-Cruz C, Ferrándiz-Pulido C, García-Patos Briones V. Melanoma in Solid Organ Transplant Recipients. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:216-224. [PMID: 33197437 DOI: 10.1016/j.ad.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/20/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022] Open
Abstract
In this review, we analyze the 3 clinical scenarios related to the development of melanoma in solid organ transplant recipients: melanoma in patients with a history of the tumor prior to a transplant, de novo melanoma following a transplant, and melanoma of donor origin. The main factors to consider in organ-transplant candidates with a history of melanoma are tumor stage, presence or absence of residual disease, and time from diagnosis to transplantation. Solid organ transplant recipients have a greater risk of melanoma than immunocompetent individuals. Mortality is also higher in this population, especially in patients with advanced melanoma, as treatment is especially challenging. Clinical history and physical examination provide the most useful information for preventing donor-to-recipient transmission of melanoma. Donor-derived melanoma has a very poor prognosis.
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Affiliation(s)
- C González-Cruz
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron. Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
| | - C Ferrándiz-Pulido
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron. Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - V García-Patos Briones
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron. Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
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15
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The Immune System and Pathogenesis of Melanoma and Non-melanoma Skin Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1268:211-226. [DOI: 10.1007/978-3-030-46227-7_11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Risk of Recurrence and 10-Year Outcomes in Surgically Treated Nonmelanoma Skin Cancer in Cardiac and Liver Transplant Recipients. Am J Clin Oncol 2020; 43:366-370. [PMID: 32217856 DOI: 10.1097/coc.0000000000000677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To report long-term outcomes of nonmelanoma skin cancer (NMSC) in immunosuppressed cardiac and liver transplant recipients (CLTR). MATERIALS AND METHODS The authors reviewed CLTR at the Mayo Clinic in Arizona from 1986 to 2013. Patient and tumor characteristics were recorded. Survival rates were calculated using the Kaplan-Meier method. Patient-specific and lesion-specific analyses were performed. Univariate and multivariate cox regressions were performed for comparisons. RESULTS Seven-hundred and forty-seven patients underwent cardiac (138) or liver (609) transplantation and of these, 97 patients (13%) developed 382 invasive NMSC. The median follow-up was 11 (range, 3 to 27) years for surviving patients. Primary treatment was mainly surgery alone. At 10 years, the local recurrence (LR) rate was 20% (95% confidence interval, 15%-28%), and 14% of patients had multiple LRs. At 10 years, LR rates were higher for T3/T4 tumors when compared with T1/T2 tumors (32.5% vs. 20%, P=0.05). At 10 years, overall survival was 79% (95% confidence interval, 64%-88%). On multivariate analysis, age 61 years and more demonstrated inferior overall survival (P<0.01). CONCLUSIONS This is the first study describing the AJCC 8th edition stage-based patterns of recurrence and long-term outcomes of surgically managed NMSC in a large cohort of immunosuppressed CLTRs. T3 and T4 tumors recur more often than early stage tumors. Further study is required to identify factors related to recurrence and guide upfront treatment intensification in this high-risk population.
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Maor D, Vajdic CM, Cumming S, Fahey V, Bala HR, Snaidr V, Brennand S, Goh MSY, Chong AH. Melanoma in a cohort of organ transplant recipients: Experience from a dedicated transplant dermatology clinic in Victoria, Australia. J Am Acad Dermatol 2019; 83:773-779. [PMID: 31706934 DOI: 10.1016/j.jaad.2019.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/15/2019] [Accepted: 11/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is limited information on the profile of melanomas diagnosed in a specialist transplant dermatology clinic. OBJECTIVE To describe the incidence and characteristics of incident primary melanomas in a cohort of organ transplant recipients (OTRs) attending a specialized transplant dermatology clinic and determine the number of pigmented lesions needed to excise for every melanoma diagnosed. METHODS A retrospective study of 327 OTRs monitored by an Australian clinic during a 10-year period. RESULTS There were 11 incident melanomas diagnosed during a total follow-up of 1280 patient-years. The mean interval between the first transplant and diagnosis was 5.5 years. Only 2 melanomas were >1 mm in Breslow thickness. Seven melanomas (64%) arose de novo. A contiguous nevus was present in 4 cases. Metastatic disease did not develop in the melanoma patients during the follow-up period, and all remain alive. The needed to excise for every melanoma diagnosed ratio was 16:1. LIMITATIONS The crude incidence rates were age standardized, unlike the comparison rates of melanoma in the general population, and the cohort was small. CONCLUSION Most melanomas diagnosed in OTR patients attending a specialized transplant dermatology service were detected early. Our data suggest early detection may reduce the proportion of OTRs presenting with thick melanomas, thus improving prognosis and patient outcomes. A needed to excise for every melanoma diagnosed ratio of 16:1 is not unreasonable for this cohort of high-risk patients. To our knowledge, this is the first time this ratio has been calculated for a cohort of OTRs.
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Affiliation(s)
- Danit Maor
- Skin and Cancer Foundation Victoria, Carlton, Victoria
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales
| | - Simon Cumming
- Skin and Cancer Foundation Victoria, Carlton, Victoria
| | | | - Harini R Bala
- Skin and Cancer Foundation Victoria, Carlton, Victoria
| | | | | | - Michelle S Y Goh
- Skin and Cancer Foundation Victoria, Carlton, Victoria; Department of Dermatology, St Vincent's Hospital Melbourne, Melbourne, Victoria
| | - Alvin H Chong
- Skin and Cancer Foundation Victoria, Carlton, Victoria; Department of Dermatology, St Vincent's Hospital Melbourne, Melbourne, Victoria; Department of Medicine (Dermatology), St Vincent's Hospital Clinical School, The University of Melbourne, Melbourne, Victoria.
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18
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How safe are organs from deceased donors with neoplasia? The results of the Italian Transplantation Network. J Nephrol 2019; 32:323-330. [DOI: 10.1007/s40620-018-00573-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/17/2018] [Indexed: 01/20/2023]
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19
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Cook M, Baker K, Redman M, Lachance K, Nguyen MH, Parvathaneni U, Bhatia S, Nghiem P, Tseng YD. Differential Outcomes Among Immunosuppressed Patients With Merkel Cell Carcinoma: Impact of Immunosuppression Type on Cancer-specific and Overall Survival. Am J Clin Oncol 2019; 42:82-88. [PMID: 30211723 PMCID: PMC8666386 DOI: 10.1097/coc.0000000000000482] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin cancer with higher incidence among whites, elderly, and immunosuppressed patients. Although immunosuppressed MCC patients are at higher risk of recurrence and MCC-related death, it is unknown whether immunosuppression type is associated with differential outcomes. MATERIALS AND METHODS We retrospectively evaluated 89 nonmetastatic MCC patients with a diagnosis of chronic immunosuppression. Immunosuppression was categorized as chronic lymphocytic leukemia (31% of cohort), other hematologic malignancies (18%), solid organ transplant (21%), autoimmune disease (21%), and human immunodeficiency virus acquired deficiency syndrome (8%). Progression-free survival (PFS) and MCC-specific survival (MSS) were estimated with the cumulative incidence function. Overall survival (OS) was estimated by the Kaplan-Meier method. RESULTS With a median follow-up of 52 months, 53 deaths occurred (42 from MCC, 7 unknown, and 4 non-MCC). Two-year PFS, MSS, and OS were 30%, 55%, and 52%, respectively. Human immunodeficiency virus/acquired deficiency syndrome and solid organ transplant patients were diagnosed with MCC at a younger age (median 55 and 59 y, respectively) and with more advanced stage disease compared with other immunosuppressed subgroups. PFS did not significantly differ among the 5 immunosuppression subgroups (P=0.30), but significant differences were observed in MSS and OS (both P=0.01). Controlling for potential confounders for OS, including age and stage, immunosuppression type was still significantly associated with risk of death (P=0.01). CONCLUSIONS Among immunosuppressed MCC patients, recurrent MCC is the major cause of mortality. The risk of death from MCC differs among immunosuppression types, suggesting important biological differences in host-tumor immune interactions.
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Affiliation(s)
| | - Kelsey Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Mary Redman
- Clinical Research Division, Fred Hutchinson Cancer Research Center
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20
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Regalla DKR, Williams GR, Paluri RK. Immune checkpoint inhibitors in the management of malignancies in transplant recipients. Postgrad Med J 2018; 94:704-708. [DOI: 10.1136/postgradmedj-2018-136081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/10/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022]
Abstract
Cancer immunotherapy, an area of active research, has thus far yielded several exciting breakthroughs in cancer treatment strategies. So far, immune checkpoint inhibitors have been the most promising method of cancer immunotherapy. CTLA-4, PD-1 and PD-L1 are the immune checkpoint molecules against which monoclonal antibodies act against and revolutionised the treatment of several malignancies. However, it is still unclear whether using these monoclonal antibodies in patients with malignancy and a history of transplant is as beneficial as in patients without a history of transplantation. The reason being, with the therapeutic benefit, also comes the inherent disadvantage of transplant rejection because of the activation of T-cells against donor antigens. So, transplant-related complications limit the usage of the checkpoint blockade therapy to treat malignancies. Here, we review the data published in this context and suggest optimal approaches to using the currently available repertoire of immunotherapies.
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Abstract
Immunosuppressed patients are at significantly increased risk of developing cutaneous malignancies. These malignancies are often more aggressive compared with the general population and require multidisciplinary care. This article highlights the incidence and risk factors of cutaneous malignancies in this cohort. The treatment and prevention strategies are discussed. There continues to be a need for evidence-driven guidelines regarding the management of skin cancers in these patients.
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Affiliation(s)
- Lindsey Collins
- Department of Dermatology, The University of Oklahoma Health Sciences Center, 619 Northeast 13th Street, Oklahoma City, OK 73104, USA.
| | - Andrew Quinn
- Department of Dermatology, The University of Oklahoma Health Sciences Center, 619 Northeast 13th Street, Oklahoma City, OK 73104, USA
| | - Thomas Stasko
- Department of Dermatology, The University of Oklahoma Health Sciences Center, 619 Northeast 13th Street, Oklahoma City, OK 73104, USA
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22
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Grant MJ, DeVito N, Salama AKS. Checkpoint inhibitor use in two heart transplant patients with metastatic melanoma and review of high-risk populations. Melanoma Manag 2018; 5:MMT10. [PMID: 30459942 PMCID: PMC6240846 DOI: 10.2217/mmt-2018-0004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/03/2018] [Indexed: 12/12/2022] Open
Abstract
Due to the unique side-effect profile of immune checkpoint inhibitors (ICIs), groups of patients deemed to be at high risk of complications were excluded from trials that proved the efficacy and safety of these agents in patients with various malignancies. Among these excluded patients were those with prior solid organ transplantation, chronic viral infections and pre-existing autoimmune diseases including paraneoplastic syndromes. We present follow-up on a patient from a previously published case report with an orthotopic heart transplantation who was treated with both cytotoxic T-lymphocyte antigen 4 and PD-1 inhibition safely, without organ rejection. Additionally, we describe the case of a patient with a cardiac allograft who also did not experience organ rejection after treatment with pembrolizumab. Through smaller trials, retrospective analyses, case series and individual case reports, we are accumulating initial data on how these agents are tolerated by the aforementioned groups. Our survey of the literature has found more evidence of organ transplant rejection in patients treated with PD-1 inhibitors than those treated with inhibitors of cytotoxic T-lymphocyte antigen 4. Patients with chronic viral infections, especially hepatitis C, seem to have little to no risk of treatment-related increase in serum RNA levels. The literature contains few documented cases of devastating exacerbations of pre-existing autoimmune disease during treatment with ICIs, and flares seem to be easily controlled by immunosuppression in the vast majority of cases. Last, several cases allude to a promising role for disease-specific antibodies and other serum biomarkers in identifying patients at high risk of developing certain immune-related adverse events, detecting subclinical immune-related adverse event onset, and monitoring treatment response to immunosuppressive therapy in patients treated with ICIs. Though these excluded populations have not been well studied in randomized placebo-controlled trials, we may be able to learn and derive hypotheses from the existing observational data in the literature.
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Affiliation(s)
- Michael J Grant
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.,Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Nicholas DeVito
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - April K S Salama
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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23
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Smedman TM, Line PD, Guren TK, Dueland S. Graft rejection after immune checkpoint inhibitor therapy in solid organ transplant recipients. Acta Oncol 2018; 57:1414-1418. [PMID: 29912605 DOI: 10.1080/0284186x.2018.1479069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Tor Magnus Smedman
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål-Dag Line
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Tormod K. Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Svein Dueland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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24
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25
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Khan AQ, Travers JB, Kemp MG. Roles of UVA radiation and DNA damage responses in melanoma pathogenesis. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2018; 59:438-460. [PMID: 29466611 PMCID: PMC6031472 DOI: 10.1002/em.22176] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 05/10/2023]
Abstract
The growing incidence of melanoma is a serious public health issue that merits a thorough understanding of potential causative risk factors, which includes exposure to ultraviolet radiation (UVR). Though UVR has been classified as a complete carcinogen and has long been recognized for its ability to damage genomic DNA through both direct and indirect means, the precise mechanisms by which the UVA and UVB components of UVR contribute to the pathogenesis of melanoma have not been clearly defined. In this review, we therefore highlight recent studies that have addressed roles for UVA radiation in the generation of DNA damage and in modulating the subsequent cellular responses to DNA damage in melanocytes, which are the cell type that gives rise to melanoma. Recent research suggests that UVA not only contributes to the direct formation of DNA lesions but also impairs the removal of UV photoproducts from genomic DNA through oxidation and damage to DNA repair proteins. Moreover, the melanocyte microenvironment within the epidermis of the skin is also expected to impact melanomagenesis, and we therefore discuss several paracrine signaling pathways that have been shown to impact the DNA damage response in UV-irradiated melanocytes. Lastly, we examine how alterations to the immune microenvironment by UVA-associated DNA damage responses may contribute to melanoma development. Thus, there appear to be multiple avenues by which UVA may elevate the risk of melanoma. Protective strategies against excess exposure to UVA wavelengths of light therefore have the potential to decrease the incidence of melanoma. Environ. Mol. Mutagen. 59:438-460, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Aiman Q Khan
- Department of Pharmacology and Toxicology, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Jeffrey B Travers
- Department of Pharmacology and Toxicology, Wright State University Boonshoft School of Medicine, Dayton, Ohio
- Dayton Veterans Affairs Medical Center, Dayton, Ohio
| | - Michael G Kemp
- Department of Pharmacology and Toxicology, Wright State University Boonshoft School of Medicine, Dayton, Ohio
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26
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Dueland S, Guren TK, Boberg KM, Reims HM, Grzyb K, Aamdal S, Julsrud L, Line PD. Acute liver graft rejection after ipilimumab therapy. Ann Oncol 2018; 28:2619-2620. [PMID: 28961840 DOI: 10.1093/annonc/mdx281] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- S Dueland
- Department of Oncology, Section for Gastroenterology, Oslo University Hospital, Oslo.
| | - T K Guren
- Department of Oncology, Section for Gastroenterology, Oslo University Hospital, Oslo
| | - K M Boberg
- Division of Surgery, Inflammation Medicine and Transplantation, Department of Transplantation Medicine, Section for Gastroenterology, Oslo University Hospital, Oslo; Institute of Clinical Medicine, University of Oslo, Oslo
| | - H M Reims
- Department of Pathology, Section for Transplantation Surgery, Oslo University Hospital, Oslo, Norway
| | - K Grzyb
- Department of Pathology, Section for Transplantation Surgery, Oslo University Hospital, Oslo, Norway
| | - S Aamdal
- Department of Oncology, Section for Gastroenterology, Oslo University Hospital, Oslo
| | - L Julsrud
- Department of Radiology and Nuclear Medicine, Section for Transplantation Surgery, Oslo University Hospital, Oslo, Norway
| | - P D Line
- Institute of Clinical Medicine, University of Oslo, Oslo; Department of Transplantation Medicine, Section for Transplantation Surgery, Oslo University Hospital, Oslo, Norway
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27
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Özcan D, Seçkin D, Haberal M. A Multicenter Survey: How Do Transplant Dermatologists Monitor Organ Transplant Recipients With Nevi? EXP CLIN TRANSPLANT 2018. [PMID: 29528027 DOI: 10.6002/ect.tond-tdtd2017.p64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The incidence and mortality of melanoma are increased in organ transplant recipients. Multiple acquired common and dysplastic nevi are risk factors for melanoma. A new or changing nevus may suggest melanoma. Strategies used by transplant dermatologists to monitor nevi are unknown. Herein, we aimed to assess the methods used by transplant dermatologists for monitoring multiple acquired common nevi, dysplastic nevi, and new or changing nevi. MATERIALS AND METHODS A questionnaire was e-mailed to 63 members of the Skin Care in Organ Transplant Patients, Europe. RESULTS Thirty-eight (92.7%) of 41 responders reported that they instruct their patients to perform regular self-skin examinations. Of 41 responders, 41.5% prescribed screening every 6 months, 36.6% prescribed it every 12 months, 12.2% prescribed it every 3 months, and 9.7% performed screening without regular intervals. Regarding type of examination, 80.5% performed full-body skin examinations with the naked eye, 70.7% performed dermoscopy of clinically suspicious nevi, 53.6% offered dermoscopic photography of dermoscopically suspicious nevi, 36.6% provided close-up photography of clinically suspicious nevi, 34.1% performed baseline total body photography, and 24.4% conducted dermoscopy of all nevi. We also found that 7.3%, 4.9%, and 4.9% performed only full-body skin examination with the naked eye, only dermoscopy of clinically suspicious nevi, and only dermoscopy of all nevi, respectively. CONCLUSIONS Dedicated transplant dermatologists perform a wide variety of nevi screening procedures in organ transplant recipients. Transplant dermatologists should include sequential digital dermoscopic imaging in their armamentarium to follow organ transplant recipients with melanocytic lesions. A combination of techniques is advisable for detecting early posttransplant melanomas.
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Affiliation(s)
- Deren Özcan
- Department of Dermatology, Baskent University Faculty of Medicine, Ankara, Turkey
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28
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Mittal A, Colegio OR. Skin Cancers in Organ Transplant Recipients. Am J Transplant 2017; 17:2509-2530. [PMID: 28556451 DOI: 10.1111/ajt.14382] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/05/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023]
Abstract
Long-term utilization of immunosuppression in organ transplant recipients (OTRs) leads to decreased immune-mediated tumor surveillance and development of malignant tumors. A delicate balance needs to be maintained in the intensity of immunosuppression to keep the risk of malignancy low without jeopardizing life-saving graft function. OTRs are prone to developing skin cancers that exhibit unique epidemiologic, pathophysiologic, and prognostic characteristics. In this review, we discuss the most commonly reported skin cancers in OTRs: squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Kaposi sarcoma, Merkel cell carcinoma, and malignant melanoma (MM). Tumors in this high-risk population are aggressive and may respond poorly to standard therapies; however, new targeted therapies are promising. Checkpoint inhibitor antibodies have been used for treatment of cutaneous SCC, Merkel cell carcinoma, and MM; epidermal growth factor receptor inhibitors have been used for cutaneous SCC; hedgehog pathway inhibitors have been used for BCC; and BRAF and MEK inhibitors are being used increasingly in the management of MM. Guidelines for dermatologic screening are variable and primarily based on expert opinion. Prospective evidence-based trials by multidisciplinary groups are needed to better define surveillance schedules for pre- and posttransplant cutaneous malignancies.
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Affiliation(s)
- A Mittal
- Departments of Dermatology, Yale University School of Medicine, New Haven, CT
| | - O R Colegio
- Departments of Dermatology, Yale University School of Medicine, New Haven, CT.,Departments of Pathology, Yale University School of Medicine, New Haven, CT.,Departments of Surgery, Yale University School of Medicine, New Haven, CT.,Yale Cancer Center, Yale University School of Medicine, New Haven, CT.,Yale-New Haven Transplantation Center, Yale University School of Medicine, New Haven, CT
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29
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Fattouh K, Ducroux E, Decullier E, Kanitakis J, Morelon E, Boissonnat P, Sebbag L, Jullien D, Euvrard S. Increasing incidence of melanoma after solid organ transplantation: a retrospective epidemiological study. Transpl Int 2017; 30:1172-1180. [PMID: 28700114 DOI: 10.1111/tri.13011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/27/2017] [Accepted: 07/07/2017] [Indexed: 12/20/2022]
Abstract
The risk of melanoma in organ transplant recipients (OTR) is increased compared with the general population. This retrospective study registered all cases of post-transplant melanoma in kidney, heart, lung, and liver transplant recipients followed in our specialized post-transplant Dermatology Clinic since 1991. The yearly prevalence of melanoma and skin carcinoma between 2000 and 2015 was computed and compared in this population. Based on another cohort of kidney transplant recipients grafted since 2005, adjusted age- and sex-standardized incidence ratio (SIR) was calculated using a renal transplantation registry. In our overall OTR cohort, between 1991 and 2000, five melanomas occurred in 1800 OTRs (0.28%), whereas between 1991 and 2015, 53 melanomas were diagnosed in 49 of 4510 OTR (1.09%), representing a 3.9-fold increase in prevalence after 2000. Remarkably, the prevalence of nonmelanoma skin cancers remained unchanged over this period. Two deaths related to melanoma were recorded with an overall follow-up of 62 months. In our cohort of 1102 renal transplant recipients, the SIR of melanoma was 4.52. Our data suggest that contrasting with nonmelanoma skin cancer, the risk of post-transplant melanoma has considerably increased over the last decade.
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Affiliation(s)
- Kinda Fattouh
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Emilie Ducroux
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Evelyne Decullier
- Unité de Recherche Clinique, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,EA Santé-Individu-Société, Université Lyon 1, Lyon, France
| | - Jean Kanitakis
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Morelon
- Department of Transplantation and Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pascale Boissonnat
- Department of Transplant Cardiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Laurent Sebbag
- Department of Transplant Cardiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sylvie Euvrard
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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31
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Schvartsman G, Perez K, Flynn JE, Myers JN, Tawbi H. Safe and effective administration of T-VEC in a patient with heart transplantation and recurrent locally advanced melanoma. J Immunother Cancer 2017; 5:45. [PMID: 28642816 PMCID: PMC5477138 DOI: 10.1186/s40425-017-0250-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Immunotherapy plays a key role in the treatment of metastatic melanoma. Patients with autoimmune conditions and/or on immunosuppressive therapy due to orthotropic transplants, however, are systematically excluded from clinical trials. Talimogene laherparepvec (T-VEC) is the first oncolytic virus to be approved by the FDA for cancer therapy. To our knowledge, this is the first report of T-VEC being administered in the setting of an organ transplant recipient. CASE PRESENTATION Here we present the case of a patient with recurrent locally advanced cutaneous melanoma receiving salvage T-VEC therapy in the setting of orthotropic heart transplantation. After 5 cycles of therapy, no evidence of graft rejection has been observed to date, and the patient achieved a complete remission, and is currently off therapy. CONCLUSION This case advocates for further investigation on the safety and efficacy of immunotherapeutic approaches, such as T-VEC, in solid organ transplant recipients.
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Affiliation(s)
- Gustavo Schvartsman
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Unit 463, Houston, TX 77030 USA
| | - Kristen Perez
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd., Houston, TX 77030 USA
| | - Jill E. Flynn
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, USA
| | - Jeffrey N. Myers
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, USA
| | - Hussein Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd., Houston, TX 77030 USA
- Department of Melanoma Medical Oncology, Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd., Houston, TX 77030 USA
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Kwatra V, Karanth NV, Priyadarshana K, Charakidis M. Pembrolizumab for metastatic melanoma in a renal allograft recipient with subsequent graft rejection and treatment response failure: a case report. J Med Case Rep 2017; 11:73. [PMID: 28315636 PMCID: PMC5357565 DOI: 10.1186/s13256-017-1229-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/01/2017] [Indexed: 12/16/2022] Open
Abstract
Background Transplant patients were excluded from the pivotal phase III trials of checkpoint inhibitors in metastatic melanoma. The efficacy and toxicity profiles of checkpoint inhibitors in this cohort of patients are not well described. To the best of our knowledge, this is the first case report of a renal transplant patient with stage IV melanoma treated with a programmed cell death protein 1 checkpoint inhibitor that led to both treatment failure and renal graft rejection. Case presentation We present a case of a 58-year-old white man with a long-standing cadaveric renal transplant who was diagnosed with a B-Raf Proto-Oncogene, Serine/Threonine Kinase wild-type metastatic melanoma. He was treated with first-line pembrolizumab but experienced subsequent graft failure and rapid disease progression. Conclusions This case highlights the risks associated with the administration of checkpoint inhibitors in patients with a renal transplant and on immunosuppressive therapy. More specifically, it adds to the literature indicating that, compared with the cytotoxic T-lymphocyte-associated protein 4 inhibitor ipilimumab, anti-programmed cell death protein 1 agents are more likely to lead to renal graft failure. Additionally, these novel immunotherapeutics may be ineffective in transplant patients; therefore, clinicians should be very aware of those risks and carefully consider selection of agents and full disclosure of the risks to their patients.
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Affiliation(s)
- Vineet Kwatra
- Medical Oncology Department, Alan Walker Cancer Centre, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, NT, 0810, Australia.
| | - Narayan V Karanth
- Medical Oncology Department, Alan Walker Cancer Centre, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, NT, 0810, Australia
| | - Kelum Priyadarshana
- NT Renal Services, Royal Darwin Hospital, Darwin, NT, Australia.,Flinders University, Adelaide, SA, Australia
| | - Michail Charakidis
- Medical Oncology Department, Alan Walker Cancer Centre, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, NT, 0810, Australia
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33
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Coughlin CC, Pérez M, Kumar MG, Jeffe DB, Bayliss SJ, Sternhell-Blackwell K. Skin cancer risk education in pediatric solid organ transplant patients: an evaluation of knowledge, behavior, and perceptions over time. Pediatr Transplant 2017; 21:10.1111/petr.12817. [PMID: 27804197 PMCID: PMC5591957 DOI: 10.1111/petr.12817] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Abstract
Skin cancer risk is elevated in solid OTRs. Studies of skin cancer awareness and sun-protection behaviors in pOTRs have not been reported. We measured effects over time of a multimodal educational intervention on knowledge of sun-protection practices and skin cancer risk, engagement in sun-protection behaviors, and self-efficacy and perceived barriers to photoprotection in pOTRs, their guardians, and a comparison group of children and guardians. Knowledge about skin cancer risk increased in pOTRs and their guardians (P≤.01) and frequency of pOTRs' sun-protection behaviors reported by pOTRs and their guardians also improved.
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Affiliation(s)
- Carrie C Coughlin
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Maria Pérez
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | | | - Donna B Jeffe
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | - Susan J Bayliss
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Kara Sternhell-Blackwell
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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34
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Walker K, Gardner K, Law A, Hawkins N, Hull P. Photoprotection Knowledge and Behaviours Among Organ Transplant Recipients. J Cutan Med Surg 2017; 21:217-220. [PMID: 28300448 DOI: 10.1177/1203475417692728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Organ transplant recipients (OTRs) are at an increased risk of developing a de novo malignant neoplasm compared to the general population. The primary contributor to skin cancer in all patients is sun exposure. OBJECTIVE In this study, we aim to ascertain both OTR skin cancer awareness and photoprotection practices. METHODS A questionnaire-based study of Saskatchewan transplant recipients. RESULTS Nearly all respondents were aware that sun exposure is the best-known cause of skin cancer and that as an OTR, they are at increased risk of skin cancer (99.3% and 90.5%, respectively). Approximately half of respondents reported wearing a hat regularly, sun avoidance between 10 am and 3 pm, or wearing sunscreen regularly (53.7%, 33.1%, and 47.9%, respectively). CONCLUSION Many OTRs are not engaging in photoprotection. Further intervention, which may include access to a dermatologist, is necessary to ensure ORTs do not experience undue morbidity and mortality secondary to skin cancer.
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Affiliation(s)
- Kirsten Walker
- 1 Division of Dermatology, University of Saskatchewan, Saskatoon, SK, Canada.,2 Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | - Kerry Gardner
- 1 Division of Dermatology, University of Saskatchewan, Saskatoon, SK, Canada.,3 Division of Dermatology, University of British Columbia, Vancouver, BC, Canada
| | - Angela Law
- 1 Division of Dermatology, University of Saskatchewan, Saskatoon, SK, Canada.,4 Division of Dermatology, Dalhousie University, Halifax, NS, Canada
| | - Nicole Hawkins
- 1 Division of Dermatology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Peter Hull
- 1 Division of Dermatology, University of Saskatchewan, Saskatoon, SK, Canada
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35
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Katabathina VS, Menias CO, Tammisetti VS, Lubner MG, Kielar A, Shaaban A, Mansour J, Surabhi VR, Hara AK. Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review. Radiographics 2016; 36:1390-407. [DOI: 10.1148/rg.2016150175] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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36
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Spain L, Higgins R, Gopalakrishnan K, Turajlic S, Gore M, Larkin J. Acute renal allograft rejection after immune checkpoint inhibitor therapy for metastatic melanoma. Ann Oncol 2016; 27:1135-1137. [PMID: 26951628 DOI: 10.1093/annonc/mdw130] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/03/2016] [Indexed: 01/08/2023] Open
Abstract
Immune checkpoint inhibitors such as ipilimumab and nivolumab improve survival in patients with advanced melanoma and are increasingly available to clinicians for use in the clinic. Their safety in organ transplant recipients is not well defined but published case reports describing treatment with ipilimumab have not been complicated by graft rejection. No cases of anti-programmed cell death protein 1 administration are reported in this group. We describe a case of acute graft rejection in a kidney transplant recipient after treatment with nivolumab, after progression on ipilimumab. Potential factors increasing the risk of graft rejection in this case are discussed, in particular the contribution of nivolumab.
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Affiliation(s)
- L Spain
- Royal Marsden NHS Foundation Trust, London
| | - R Higgins
- University Hospitals Coventry and Warwickshire, Coventry
| | | | - S Turajlic
- Royal Marsden NHS Foundation Trust, London; The Francis Crick Institute, Lincoln's Inn Fields Laboratory, London, UK
| | - M Gore
- Royal Marsden NHS Foundation Trust, London
| | - J Larkin
- Royal Marsden NHS Foundation Trust, London.
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37
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Alhamad T, Venkatachalam K, Linette GP, Brennan DC. Checkpoint Inhibitors in Kidney Transplant Recipients and the Potential Risk of Rejection. Am J Transplant 2016; 16:1332-3. [PMID: 26752406 DOI: 10.1111/ajt.13711] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- T Alhamad
- Renal Division, Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO.,Transplant Epidemiology Research Collaboration (TERC), Institute of Public Health, Washington University in St. Louis, St. Louis, MO
| | - K Venkatachalam
- Renal Division, Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - G P Linette
- Division of Oncology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - D C Brennan
- Renal Division, Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
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38
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Zwald F, Leitenberger J, Zeitouni N, Soon S, Brewer J, Arron S, Bordeaux J, Chung C, Abdelmalek M, Billingsley E, Vidimos A, Stasko T. Recommendations for Solid Organ Transplantation for Transplant Candidates With a Pretransplant Diagnosis of Cutaneous Squamous Cell Carcinoma, Merkel Cell Carcinoma and Melanoma: A Consensus Opinion From the International Transplant Skin Cancer Collaborative (ITSCC). Am J Transplant 2016; 16:407-13. [PMID: 26820755 DOI: 10.1111/ajt.13593] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 01/25/2023]
Abstract
Advancements in solid organ transplantation successfully extend the lives of thousands of patients annually. The tenet of organ stewardship aims to prevent the futile expenditure of scarce donor organs in patient populations with high mortality risk, to the detriment of potential recipients with greater predicted life expectancy. The development of skin cancer posttransplantation portends tremendous morbidity, adversely affecting quality of life for many transplant recipients. This special article, provided by of members of the International Transplant Skin Cancer Collaborative (ITSCC), will provide the transplant professional with a consensus opinion and recommendations as to an appropriate wait period pretransplantation for transplant candidates with a history of either cutaneous squamous cell carcinoma, malignant melanoma, or Merkel cell carcinoma.
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Key Words
- cancer, malignancy, neoplasia
- clinical research, practice
- dermatology
- malignancy
- melanoma, cancer, malignancy, neoplasia
- metastatic disease
- neoplasia
- organ transplantation in general
- risk factors, cancer, malignancy, neoplasia
- skin, nonmelanoma, cancer
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Affiliation(s)
- F Zwald
- Piedmont Transplant Institute, Atlanta, GA
| | | | - N Zeitouni
- Department of Dermatology, University of Arizona, Tucson, AZ
| | - S Soon
- Department of Dermatology, Scripps Clinic, La Jolla, CA
| | - J Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - S Arron
- Department of Dermatology, UCSF, San Francisco, CA
| | - J Bordeaux
- Department of Dermatology, Case Medical Center, Cleveland, OH
| | - C Chung
- Department of Dermatology, Drexel University, Philadelphia, PA
| | - M Abdelmalek
- Department of Dermatology, Drexel University, Philadelphia, PA
| | | | - A Vidimos
- Department of Dermatology, Cleveland Clinic, Cleveland, OH
| | - T Stasko
- Department of Dermatology, Oklahoma University, Oklahoma City, OK
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39
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Tufaro AP, Azoury SC, Crompton JG, Straughan DM, Reddy S, Prasad NB, Shi G, Fischer AC. Rising incidence and aggressive nature of cutaneous malignancies after transplantation: An update on epidemiology, risk factors, management and surveillance. Surg Oncol 2015; 24:345-52. [DOI: 10.1016/j.suronc.2015.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/16/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023]
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40
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Garrett GL, He SY, Sabouni N, Daud A, Arron ST. Combined dabrafenib and trametinib therapy in metastatic melanoma and organ transplantation: Case report and review of the literature. JAAD Case Rep 2015; 1:S23-5. [PMID: 27051803 PMCID: PMC4809575 DOI: 10.1016/j.jdcr.2015.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Giorgia L Garrett
- Department of Dermatology, University of California, San Francisco, California
| | - Steven Y He
- Department of Medicine, Harvard/Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Adil Daud
- Department of Medicine, University of California, San Francisco, California
| | - Sarah T Arron
- Department of Dermatology, University of California, San Francisco, California
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41
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Qin R, Salama AK. Report of ipilimumab in a heart transplant patient with metastatic melanoma on tacrolimus. Melanoma Manag 2015; 2:311-314. [PMID: 30190859 DOI: 10.2217/mmt.15.27] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Ipilimumab is the first immunotherapy shown to increase overall survival in patients with metastatic melanoma. Currently, there are no accepted guidelines for use of ipilimumab in organ transplant patients. There is only one report in the literature on successful administration of ipilimumab in two kidney transplant recipients. In this report, a heart transplant patient with metastatic melanoma was successfully treated with ipilimumab. He experienced no adverse drug reactions. However, after standard treatment with regimen of four doses at 3 mg/kg, he experienced disease progression. Here, we address concerns of organ rejection or ineffective treatment when using ipilimumab or other immune checkpoint inhibitors in patients who are chronically immunosuppressed.
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Affiliation(s)
- Rosie Qin
- School of Medicine, Duke University Medical Center, Durham, NC 27710, USA.,School of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - April Ks Salama
- Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA.,Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA
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42
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Murthy RK, Chisolm SS, Stoff BK. A pigmented lesion on a brain-dead organ donor: Should the dermatologist intervene before transplant? J Am Acad Dermatol 2015; 73:1062-5. [PMID: 26568341 DOI: 10.1016/j.jaad.2015.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 07/25/2015] [Accepted: 08/14/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Rajini K Murthy
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah S Chisolm
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Department of Dermatology, The Emory Center for Ethics, Atlanta, Georgia.
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43
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Džambová M, Sečníková Z, Jiráková A, Jůzlová K, Viklický O, Hošková L, Göpfertovà D, Hercogová J. Malignant melanoma in organ transplant recipients: incidence, outcomes, and management strategies: a review of literature. Dermatol Ther 2015; 29:64-8. [PMID: 26460720 DOI: 10.1111/dth.12276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Malignant melanoma is considered to be an immunogenic tumor, which is expected to change its behaviour in the field of immunosuppression. Although the incidence of melanoma in organ transplant recipients is increased to a smaller degree than in non-melanoma skin cancer, its potential morbidity and mortality has to be considered in the posttransplant care. The aim of this review is to investigate the relationship between melanoma and immunosuppression and to discuss management strategies for different melanoma scenarios in pre-transplant as well as posttransplant period.
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Affiliation(s)
- Martina Džambová
- Department of Dermatology, 2nd Medical Faculty, Charles University in Prague and Bulovka Hospital, Prague, Czech Republic
| | - Zuzana Sečníková
- Department of Dermatology, 2nd Medical Faculty, Charles University in Prague and Bulovka Hospital, Prague, Czech Republic
| | - Anna Jiráková
- Department of Dermatology, 2nd Medical Faculty, Charles University in Prague and Bulovka Hospital, Prague, Czech Republic
| | - Kateřina Jůzlová
- Department of Dermatology, 2nd Medical Faculty, Charles University in Prague and Bulovka Hospital, Prague, Czech Republic
| | - Ondřej Viklický
- Department of Nephrology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lenka Hošková
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Dana Göpfertovà
- Department of Epidemiology, 2nd Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Jana Hercogová
- Department of Dermatology, 2nd Medical Faculty, Charles University in Prague and Bulovka Hospital, Prague, Czech Republic
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44
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Skin Cancer in the Crosshairs: Highlights from the Biennial Scientific Retreat of International Transplant Skin Cancer Collaborative and Skin Care in Organ Transplant Recipients Europe. Transplant Direct 2015; 1:e26. [PMID: 27500228 PMCID: PMC4946475 DOI: 10.1097/txd.0000000000000535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The International Transplant Skin Cancer Collaborative (ITSCC) is an organization comprising of physicians; transplant surgeons and basic science research scientists dedicated in providing optimal care and ongoing research advancements in solid organ transplant recipients to improve patient outcome and quality of life. As medical advances occur, it is anticipated that the sheer number of solid organ transplantations occurring worldwide will continue to increase. The long-term medication associated immunosuppression improves graft survival, but as a consequence, these individuals become increasingly susceptible to various cutaneous malignancies, lymphoproliferative disorders and infections. Squamous cell carcinoma is the most frequently encountered skin cancer and increases 65- to 250-fold [Jensen et al., Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens. J Am Acad Dermatol. 1999;40:177-186; Lindelöf et al., Incidence of skin cancer in 5356 patients following organ transplantation. Br J Dermatol. 2000; 143:513-519]. However, the rates of basal cell carcinoma, Merkel cell carcinoma and melanoma also increase in organ transplant recipients leading to significant morbidity as well as mortality [Berg and Otley. Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. J Am Acad Dermatol. 2002; 47:1-20]. In October 2014, the International Transplant Skin Cancer Collaborative and its equivalent European counterpart, Skin Care in Organ Transplant Recipients Europe held its 10th biennial meeting in Essex, MA to discuss the clinical conundrums and the evolving research pertinent to the field. This meeting report provides a synthesis of all the clinical and research data presented at the 4-day meeting.
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45
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Krynitz B, Rozell BL, Lyth J, Smedby KE, Lindelöf B. Cutaneous malignant melanoma in the Swedish organ transplantation cohort: A study of clinicopathological characteristics and mortality. J Am Acad Dermatol 2015; 73:106-113.e2. [PMID: 25929720 DOI: 10.1016/j.jaad.2015.03.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/02/2015] [Accepted: 03/21/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Risk of cutaneous melanoma is increased among organ transplant recipients (OTRs) but outcome has rarely been evaluated. OBJECTIVE We sought to assess melanoma characteristics and prognosis among OTRs versus the general population. METHODS Using Swedish health care registers, we identified melanomas in OTRs (n = 49) and in the general population (n = 22,496), given a diagnosis between 1984 and 2008 and followed up through December 31, 2012. Tumor slides of posttransplantation melanomas were reviewed. Odds ratios for comparison of histopathological characteristics and hazard ratios of melanoma-specific death were calculated. RESULTS Among OTRs the trunk was the most common anatomic melanoma site (50% among female vs 51% among male) and 73% (n = 36) of all melanomas were histologically associated with a melanocytic nevus, 63% (n = 31) atypical/dysplastic. Compared with population melanomas, posttransplantation melanomas were more advanced at diagnosis (Clark level III-V: odds ratio 2.2 [95% confidence interval 1.01-4.7, P = .03], clinical stages III-IV: odds ratio 4.2 [1.6-10.8, P = .003]). Risk of melanoma-specific death was increased among OTRs: adjusted hazard ratio 3.0 (1.7-5.3, P = .0002). LIMITATIONS Only posttransplantation melanoma slides were reviewed. CONCLUSIONS Melanomas were more advanced at diagnosis and melanoma-specific survival was poorer in OTRs than in the general population. Prophylactic excision of truncal nevi among OTRs may be advised.
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Affiliation(s)
- Britta Krynitz
- Department of Pathology and Cytology, Karolinska University Laboratories, Stockholm, Sweden; Unit of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Barbro Lundh Rozell
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Clinical Pathology and Clinical Genetics, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Regional Cancer Center Southeast, University Hospital, Linköping, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Bernt Lindelöf
- Unit of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
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46
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Bosma S, Van Wijk MJ, Richters CD, Beele H. The risk of transmitting cutaneous malignancy through skin transplantation: a literature-based risk assessment. Cell Tissue Bank 2015; 16:503-12. [PMID: 25631853 DOI: 10.1007/s10561-015-9497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
Abstract
According to the European Union Tissues and Cells Directives donation of tissue is contraindicated in the presence of or a previous history of malignant disease, with the exception of cutaneous basal cell carcinoma. Skin cancer is the most common cancer. Due to ultraviolet light exposure and increasing life expectancy an increasing prevalence of malignant or premalignant skin lesions is observed, which may result in a decline of the availability of skin for transplantation. A risk assessment based on published studies and expert opinion was performed in order to investigate the risk of transmitting malignant or premalignant skin lesions through tissue transplantation, and more particular through skin transplantation. The scarcity of data concerning cancer transmission in tissue transplantation was challenging. Circumstantial evidence, available for organ transplantation, was used to develop the following policy proposal for skin transplantation and cutaneous tumours. Malignant melanoma is an absolute contraindication for the donation of skin and also of other tissues, whereas, non-lesional skin and other tissues of a donor with non-melanoma skin cancer (basal cell and squamous cell carcinoma) or with a premalignant skin lesion can be considered for transplantation. The above mentioned protocol proposal might serve as a prototype for analogous protocols for non-cutaneous malignancies.
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Affiliation(s)
- Sarah Bosma
- Department of Dermatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | | | | | - Hilde Beele
- Department of Dermatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.,Tissue Bank, Ghent University Hospital, Ghent, Belgium
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47
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Berben L, Denhaerynck K, Dobbels F, Engberg S, Vanhaecke J, Crespo-Leiro MG, Russell CL, De Geest S. Building research initiative group: chronic illness management and adherence in transplantation (BRIGHT) study: study protocol. J Adv Nurs 2014; 71:642-54. [DOI: 10.1111/jan.12519] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Lut Berben
- Institute of Nursing Science; University of Basel; Switzerland
- Health Services and Nursing Research; KU Leuven; Belgium
| | | | | | - Sandra Engberg
- Clinical Education; School of Nursing; University of Pittsburgh; Pennsylvania USA
| | - Johan Vanhaecke
- Division of Cardiology; University Hospitals Leuven; Belgium
| | - Maria G. Crespo-Leiro
- Heart Failure and Heart Transplant Unit; Hospital Universitario A Coruña Spain; La Coruña Spain
| | | | - Sabina De Geest
- Institute of Nursing Science; University of Basel; Switzerland
- Health Services and Nursing Research; KU Leuven; Belgium
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48
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Brin L, Zubair AS, Brewer JD. Optimal management of skin cancer in immunosuppressed patients. Am J Clin Dermatol 2014; 15:339-56. [PMID: 25015705 DOI: 10.1007/s40257-014-0085-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Skin cancer is the most common malignancy in humans with basal cell carcinoma representing the majority of cases in the general population. The prevalence of skin cancer is increased amongst immunosuppressed patients such as those with lymphoproliferative disorders including non-Hodgkin lymphoma and chronic lymphocytic leukemia or those with iatrogenic immunosuppression following organ transplantation. In addition, these patients experience greater morbidity and mortality associated with skin cancers. The most common skin cancer in immunosuppressed patients is squamous cell carcinoma, which often presents with more aggressive features and has a greater rate of metastasis. This article reviews the risk factors, etiology, clinical presentation, and prevalence of skin cancer amongst immunosuppressed patients, including organ transplant, lymphoproliferative disorders, autoimmune disorders, and human immunodeficiency virus. We also provide a comprehensive review of treatment guidelines for immunosuppressed patients with cutaneous malignancy. Surgical therapy is the cornerstone of treatment; however, we also discuss pharmacologic treatment options, lifestyle modifications, and revision of immunosuppressive regimens.
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49
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Hanlon A, Colegio OR. The cutting edge of skin cancer in transplant recipients: scientific retreat of international transplant Skin Cancer Collaborative and Skin Cancer in Organ Transplant Patients Europe. Am J Transplant 2014; 14:1012-5. [PMID: 24612476 PMCID: PMC4149908 DOI: 10.1111/ajt.12681] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/09/2014] [Accepted: 01/22/2014] [Indexed: 01/25/2023]
Abstract
The International Transplant Skin Cancer Collaborative (ITSCC) is an organization of more than 300 physicians and scientists focused on the study of dermatologic changes following solid organ transplantation. Transplant patients have a 100-fold increased risk of developing skin cancer. In October 2012, ITSCC and its European counterpart Skin Cancer in Organ Transplant Patients Europe held a joint biennial retreat in Essex, MA to discuss novel findings in the pathogenesis and management of skin cancer in solid organ transplant recipients. This meeting report is a summary of the novel findings discussed.
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Affiliation(s)
- A. Hanlon
- Corresponding author: Allison Hanlon,
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French ENT Society (SFORL) guidelines for the management of immunodeficient patients with head and neck cancer of cutaneous origin. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:121-9. [DOI: 10.1016/j.anorl.2014.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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