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Ritter A, Bachar G, Feinmesser R, Shpitzer T, Popovtzer A, Rabinovics N. Nonmelanoma skin cancer of the head and neck region in solid organ transplant recipients. Head Neck 2018; 41:374-380. [DOI: 10.1002/hed.25467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/17/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Amit Ritter
- Department of Otolaryngology, Head and Neck SurgeryRabin Medical Center Petach Tikva Israel
| | - Gideon Bachar
- Department of Otolaryngology, Head and Neck SurgeryRabin Medical Center Petach Tikva Israel
| | - Raphael Feinmesser
- Department of Otolaryngology, Head and Neck SurgeryRabin Medical Center Petach Tikva Israel
| | - Thomas Shpitzer
- Department of Otolaryngology, Head and Neck SurgeryRabin Medical Center Petach Tikva Israel
| | - Aron Popovtzer
- Institute of Oncology, Davidoff CenterRabin Medical Center Petach Tikva Israel
| | - Naomi Rabinovics
- Department of Otolaryngology, Head and Neck SurgeryRabin Medical Center Petach Tikva Israel
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102
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Baust JM, Rabin Y, Polascik TJ, Santucci KL, Snyder KK, Van Buskirk RG, Baust JG. Defeating Cancers' Adaptive Defensive Strategies Using Thermal Therapies: Examining Cancer's Therapeutic Resistance, Ablative, and Computational Modeling Strategies as a means for Improving Therapeutic Outcome. Technol Cancer Res Treat 2018; 17:1533033818762207. [PMID: 29566612 PMCID: PMC5871056 DOI: 10.1177/1533033818762207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diverse thermal ablative therapies are currently in use for the treatment of cancer. Commonly applied with the intent to cure, these ablative therapies are providing promising success rates similar to and often exceeding "gold standard" approaches. Cancer-curing prospects may be enhanced by deeper understanding of thermal effects on cancer cells and the hosting tissue, including the molecular mechanisms of cancer cell mutations, which enable resistance to therapy. Furthermore, thermal ablative therapies may benefit from recent developments in computer hardware and computation tools for planning, monitoring, visualization, and education. METHODS Recent discoveries in cancer cell resistance to destruction by apoptosis, autophagy, and necrosis are now providing an understanding of the strategies used by cancer cells to avoid destruction by immunologic surveillance. Further, these discoveries are now providing insight into the success of the diverse types of ablative therapies utilized in the clinical arena today and into how they directly and indirectly overcome many of the cancers' defensive strategies. Additionally, the manner in which minimally invasive thermal therapy is enabled by imaging, which facilitates anatomical features reconstruction, insertion guidance of thermal probes, and strategic placement of thermal sensors, plays a critical role in the delivery of effective ablative treatment. RESULTS The thermal techniques discussed include radiofrequency, microwave, high-intensity focused ultrasound, laser, and cryosurgery. Also discussed is the development of thermal adjunctive therapies-the combination of drug and thermal treatments-which provide new and more effective combinatorial physical and molecular-based approaches for treating various cancers. Finally, advanced computational and planning tools are also discussed. CONCLUSION This review lays out the various molecular adaptive mechanisms-the hallmarks of cancer-responsible for therapeutic resistance, on one hand, and how various ablative therapies, including both heating- and freezing-based strategies, overcome many of cancer's defenses, on the other hand, thereby enhancing the potential for curative approaches for various cancers.
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Affiliation(s)
- John M Baust
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA
| | - Yoed Rabin
- 3 Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Thomas J Polascik
- 4 Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kimberly L Santucci
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA
| | - Kristi K Snyder
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA
| | - Robert G Van Buskirk
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA.,5 Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| | - John G Baust
- 2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA.,5 Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
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Abstract
Posttransplant malignancy is a leading cause of death after solid organ transplantation (SOT). Recipients of SOT are at significantly higher risk of multiple cancers compared with the general population, most notably nonmelanoma skin cancer and posttransplant lymphoproliferative disorders. Risk factors for posttransplant malignancy include history of malignancy, immunosuppression, oncogenic viral infections, sun exposure, and disease-specific associations. Early detection and treatment of malignancies can improve survival.
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104
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Ochoa-López JM, Gabilondo-Pliego B, Collura-Merlier S, Herrera-Cáceres JO, de Zavaleta MS, Rodríguez-Covarrubias FT, Feria-Bernal G, Gabilondo-Navarro F, Castillejos-Molina RA. Incidence and treatment of malignant tumors of the genitourinary tract in renal transplant recipients. Int Braz J Urol 2018; 44:874-881. [PMID: 29757570 PMCID: PMC6237530 DOI: 10.1590/s1677-5538.ibju.2017.0471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 04/04/2018] [Indexed: 01/20/2023] Open
Abstract
Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.
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Affiliation(s)
- Juan Manuel Ochoa-López
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
| | | | - Sylvain Collura-Merlier
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
| | - Jaime O Herrera-Cáceres
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
| | | | | | - Guillermo Feria-Bernal
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
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105
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Stenman C, Gonzalez H, Gillstedt M, Dellgren G, Hasséus B, Holmberg E, Rexius H, Öhman J, Paoli J. Degree of differentiation of cutaneous squamous cell carcinoma: a comparison between a Swedish cohort of organ transplant recipients and immunocompetent patients. Dermatol Pract Concept 2018; 8:330-336. [PMID: 30479868 PMCID: PMC6246062 DOI: 10.5826/dpc.0804a18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/23/2018] [Indexed: 12/14/2022] Open
Abstract
Background Organ transplant recipients (OTRs) have a very high risk of developing cutaneous squamous cell carcinoma (cSCC). Immunosuppressed OTRs may have a higher proportion of poorly differentiated cSCC than non-OTRs. Objectives The aim of this study was to investigate the degree of differentiation of cSCCs in OTRs compared with immunocompetent individuals. Patients/Methods Data from the Swedish Cancer Registry were crosschecked with data from the Transplant registry of the Transplant Institute at Sahlgrenska University Hospital in Gothenburg, Sweden. All OTRs with a diagnosis of cSCC, basosquamous carcinoma, and/or cSCC in situ established at the Department of Dermatology, Sahlgrenska University Hospital, during 2002–2015 were included. The control group consisted of non-OTRs with the same diagnoses during the same time period. Results During 2002–2015, 82 OTRs diagnosed with 515 tumors and 883 non-OTRs with 1,247 tumors were included. OTRs developed 0.47 tumors/year vs 0.10 tumors/year for non-OTRs, but no significant differences were observed in the degree of tumor differentiation of invasive cSCCs between OTRs and non-OTRs (P = 0.4). The distribution of poorly, moderately, and well-differentiated invasive cSCCs among OTRs and non-OTRs were 8.5% vs 12.5%, 22.1% vs 29.9%, and 69.4% vs 57.6%, respectively. Conclusions OTRs do not develop a higher proportion of poorly differentiated cSCCs than non-OTRs.
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Affiliation(s)
- Caroline Stenman
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Gonzalez
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Gillstedt
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Dellgren
- Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden
| | - Helena Rexius
- Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenny Öhman
- Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Rousseau B, Guillemin A, Duvoux C, Neuzillet C, Tlemsani C, Compagnon P, Azoulay D, Salloum C, Laurent A, de la Taille A, Salomon L, Cholley I, Haioun C, Dupuis J, Wolkenstein P, Matignon MB, Grimbert P, Tournigand C. Optimal oncologic management and mTOR inhibitor introduction are safe and improve survival in kidney and liver allograft recipients withde novocarcinoma. Int J Cancer 2018; 144:886-896. [DOI: 10.1002/ijc.31769] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 06/30/2018] [Accepted: 07/17/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Benoit Rousseau
- Medical Oncology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- IMRB, INSERM U955; University Paris Est Créteil, Team 18; 94100 Créteil France
| | - Aude Guillemin
- Medical Oncology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
| | - Christophe Duvoux
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Hepatology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Cindy Neuzillet
- Medical Oncology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
| | - Camille Tlemsani
- Medical Oncology, Cochin Hospital; Assistance Publique-Hôpitaux de Paris; 75014 Paris France
| | - Philippe Compagnon
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Visceral and hepatobiliary surgery, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Daniel Azoulay
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Visceral and hepatobiliary surgery, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Chaddy Salloum
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Visceral and hepatobiliary surgery, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Alexis Laurent
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Visceral and hepatobiliary surgery, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Alexandre de la Taille
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Urology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Laurent Salomon
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Urology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Irène Cholley
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Urology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Corinne Haioun
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Lymphoid Malignancies Unit, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Jehan Dupuis
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Lymphoid Malignancies Unit, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Pierre Wolkenstein
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Dermatology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Marie-Bénédicte Matignon
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Nephrology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Philippe Grimbert
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
- Nephrology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
| | - Christophe Tournigand
- Medical Oncology, Henri Mondor Hospital; Assistance Publique-Hôpitaux de Paris; 94100 Créteil France
- Faculty of Medicine; University of Paris-Est; 94000 Créteil France
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107
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A review of adenotonsillar hypertrophy and adenotonsillectomy in children after solid organ transplantation. Int J Pediatr Otorhinolaryngol 2018; 114:29-35. [PMID: 30262363 DOI: 10.1016/j.ijporl.2018.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Paediatric solid organ transplantation is an increasingly successful treatment. Improved survival is paralleled by increased secondary complications of immunosuppression, including post-transplant lymphoproliferative disease (PTLD). PTLD frequently presents in Waldeyer's lymphatic ring. Adenotonsillar hypertrophy (ATH) is common in children, however in children after transplant, ATH may indicate PTLD. We review the literature on ATH and the role of adenotonsillectomy in children after transplantation. METHODS A comprehensive literature search was performed on the 26 th September 2017 of Ovid Medline (1996-September 2017), Embase (1996-2017) and EBM reviews (Cochrane database of systematic reviews 2005-September 20 th 2017). Results were limited to English language publications within the last 20 years. Abstracts were screened for relevance to PTLD and ATH in the paediatric solid organ transplantation population. Screening of the bibliographies identified further articles. RESULTS 85 unique articles were screened to yield 18 relevant publications. 10 were retrospective studies and 8 were prospective studies. CONCLUSION In children, we report a PTLD incidence of up to 15%, with up to 63% of cases presenting in the head and neck. Histological examination of adenotonsillectomy specimens found PTLD in a mean 5.7% (range 0-39%). We found a lack of prospective studies into this topic and further high quality research is needed. Clinical assessment of ATH in children after transplantation and when to perform a diagnostic adenotonsillectomy remains challenging. Children with ATH warrant prompt further investigation and support from colleagues in transplantation and oncology is required. .
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108
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Teo SH, Lee KG, Lim GH, Koo SX, Ramirez ME, Chow KY, Kee T. Incidence, risk factors and outcomes of malignancies after kidney transplantation in Singapore: a 12-year experience. Singapore Med J 2018; 60:253-259. [PMID: 30311626 DOI: 10.11622/smedj.2018122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Data on malignancy after kidney transplantation (KTX) is limited in our region, leading to challenges in the care of renal allograft recipients. We aimed to examine the epidemiology, risk factors and outcomes of post-KTX patients. METHODS A retrospective cohort study was conducted of 491 patients who underwent KTX from 1 January 2000 to 31 December 2011. Data linkage analysis was done between our centre and the National Registry of Diseases Office to determine the standardised incidence ratio (SIR), standardised mortality ratio (SMR) and risk factors for malignancy after KTX. RESULTS 31 patients (61.3% male) developed malignancy during this period, and their median age at diagnosis was 50 (range 18-65) years. Median time to malignancy diagnosis was 2.6 (range 0.3-7.9) years, with cumulative incidence of 1%, 4% and 10% at one, five and ten years, respectively. The commonest malignancy type was lymphoma, followed by kidney cancer, colorectal cancer and malignancy of the male genital organs. Multivariate analysis identified cyclosporine use as an independent risk factor for malignancy. Compared to the general population, KTX recipients had higher malignancy and mortality rates after malignancy diagnosis (SIR 3.36; SMR 9.45). Survival rates for KTX recipients with malignancy versus those without malignancy were 100%, 93% and 64% versus 97%, 93% and 83% at one, five and ten years, respectively. CONCLUSION KTX was associated with higher mortality and incidence of malignancy. Newer immunosuppressive agents and induction therapies were not found to be risk factors for malignancy, possibly due to our relatively small sample size.
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Affiliation(s)
- Su Hooi Teo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Kian-Guan Lee
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Gek Hsiang Lim
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Si Xuan Koo
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Khuan Yew Chow
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Terence Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore
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Taborelli M, Piselli P, Ettorre GM, Lauro A, Galatioto L, Baccarani U, Rendina M, Shalaby S, Petrara R, Nudo F, Toti L, Sforza D, Fantola G, Cimaglia C, Agresta A, Vennarecci G, Pinna AD, Gruttadauria S, Risaliti A, Di Leo A, Burra P, Rossi M, Tisone G, Zamboni F, Serraino D. Risk of virus and non-virus related malignancies following immunosuppression in a cohort of liver transplant recipients. Italy, 1985-2014. Int J Cancer 2018; 143:1588-1594. [PMID: 29693248 DOI: 10.1002/ijc.31552] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/19/2018] [Accepted: 04/06/2018] [Indexed: 02/05/2023]
Abstract
This cohort study assessed, in Italy, the overall pattern of risk of de novo malignancies following liver transplantation (LT). The study group included 2,832 individuals who underwent LT between 1985 and 2014 in nine centers all over Italy. Person-years (PYs) at cancer risk were computed from 30 days after LT to the date of cancer diagnosis, to the date of death or to the end of follow-up. Excess cancer risk, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). During 18,642 PYs, 246 LT recipients developed 266 de novo malignancies, corresponding to a 1.8-fold higher cancer risk (95% CI: 1.6-2.0). SIRs were particularly elevated for virus-related malignancies, including Kaposi's sarcoma (SIR = 53.6, 95% CI: 30.0-88.5), non-Hodgkin lymphomas (SIR = 7.1, 95% CI: 4.8-10.1) and cervix uteri (SIR = 5.4, 95% CI: 1.1-15.8). Among virus-unrelated malignancies, elevated risks emerged for head and neck (SIR = 4.4, 95% CI: 3.1-6.2), esophagus (SIR = 6.7, 95% CI: 2.9-13.3) and adrenal gland (SIR = 22.9, 95% CI: 2.8-82.7). Borderline statistically significant elevated risks were found for lung cancer (SIR = 1.4, 95% CI: 1.0-2.1) and skin melanoma (SIR = 2.6, 95% CI: 1.0-5.3). A reduced risk emerged for prostate cancer (SIR = 0.1, 95% CI: 0.0-0.5). These findings underline the need of preventive interventions and early detection of malignancies, specifically tailored to LT recipients.
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Affiliation(s)
- Martina Taborelli
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Pierluca Piselli
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | | | - Augusto Lauro
- Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Laura Galatioto
- Department of Gastroenterology and Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), University of Pittsburgh Medical Center, Palermo, Italy
| | | | - Maria Rendina
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Sarah Shalaby
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Raffaella Petrara
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Francesco Nudo
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Luca Toti
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Daniele Sforza
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Giovanni Fantola
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Claudia Cimaglia
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Alessandro Agresta
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Antonio Daniele Pinna
- Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Salvatore Gruttadauria
- Department of Gastroenterology and Hepatology, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), University of Pittsburgh Medical Center, Palermo, Italy
| | | | - Alfredo Di Leo
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic, Sapienza University, Rome, Italy
| | - Giuseppe Tisone
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Fausto Zamboni
- Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
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110
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Low-dose-rate brachytherapy for prostate cancer in renal transplant recipients. Brachytherapy 2018; 17:808-815. [DOI: 10.1016/j.brachy.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/02/2018] [Accepted: 06/07/2018] [Indexed: 12/17/2022]
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111
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Rahatli S, Altundag O, Ayvazoglu Soy E, Moray G, Haberal M. Posttransplant Malignancies in Adult Renal and Hepatic Transplant Patients. EXP CLIN TRANSPLANT 2018; 18:470-473. [PMID: 30119617 DOI: 10.6002/ect.2018.0177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The risk of some cancer types increases after organ transplant compared with that shown in the general population; this has been well documented in clinical studies. With patients having longer survival and with the higher number of transplant procedures, cancer is an increasing health concern at high-volume transplant centers. Malignancy has an important effect on short- and long-term graft and patient survival. In this study, we evaluated cancer frequency during transplant patient follow-up. MATERIALS AND METHODS This single-center retrospective study included patients who underwent solid-organ transplant at the Baskent University Medical Faculty Hospital from 1997 to 2017. Renal and hepatic transplant patients older than 16 years at the time of transplant and diagnosed with cancer after transplant were included the study. In total, 1176 of 2018 renal transplant recipients and 274 of 548 hepatic transplant recipients met the inclusion criteria. RESULTS We determined that 52 of 1176 renal transplant (4.5%) and 9 of 274 hepatic transplant patients (3.3%) developed posttransplant cancer during follow-up. Of 61 total patients with cancer posttransplant, 44 were males (72.1%) and 17 were females (27.9%), with median age at transplant of 39.2 years. Overall, the incidence of cancer in transplant recipients was 4.2%. The most frequent cancers were basal and squamous skin cancers, which were seen in 18 patients (29%), and Kaposi sarcoma, which was seen in 11 patients (18%). Of the 61 patients who developed cancer, 43 (70%) were still alive at the time of this study. CONCLUSIONS Despite recent positive developments in the use of immunosuppressive drugs, posttransplant malignancy is still a health problem. Fortunately, most cancers in this patient group have good prognosis and can be cured by surgical resection. Transplant physicians should aim for early detection of these diseases.
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Affiliation(s)
- Samed Rahatli
- Department of Medical Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
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Voriconazole exposure and risk of cutaneous squamous cell carcinoma among lung or hematopoietic cell transplant patients: A systematic review and meta-analysis. J Am Acad Dermatol 2018; 80:500-507.e10. [PMID: 30130598 DOI: 10.1016/j.jaad.2018.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/26/2018] [Accepted: 08/11/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Current evidence about the association between voriconazole and risk of cutaneous squamous cell carcinoma (SCC) remains inconsistent. OBJECTIVE To assess the association between voriconazole use and risk of SCC. METHODS We systematically searched PubMed and Embase and performed a random effects model meta-analysis to calculate the pooled relative risk (RR) with a 95% confidence interval (CI). RESULTS Of the 8 studies involving a total of 3710 individuals with a lung transplant or hematopoietic cell transplant that were included in the qualitative analysis, 5 were included in the meta-analysis. Use of voriconazole was significantly associated with increased risk of SCC (RR, 1.86; 95% CI, 1.36-2.55). The increased risk did not differ according to type of transplantation or adjustment for sun exposure. Longer duration of voriconazole use was found to be positively associated with risk of SCC (RR, 1.72; 95% CI, 1.09-2.72). Voriconazole use was not associated with increased risk of basal cell carcinoma (RR, 0.84; 95% CI, 0.41-1.71). LIMITATIONS There were some heterogeneities in the retrospective observational studies. CONCLUSIONS Our findings support an increased risk of SCC associated with voriconazole in individuals with a lung transplant or hematopoietic cell transplant. Routine dermatologic surveillance should be performed, especially among individuals at high risk of developing SCC.
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113
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Balhareth A, Reynolds IS, Solon JG, Harte EG, Boland F, O'Sullivan JM, Burke JP, Little D, McNamara DA. Thirty-seven-year Population-based Study of Colorectal Cancer Rates in Renal Transplant Recipients in Ireland. Transplant Proc 2018; 50:3434-3439. [PMID: 30577217 DOI: 10.1016/j.transproceed.2018.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/08/2018] [Accepted: 07/18/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Renal transplantation is associated with an increased risk of neoplasia, including colorectal cancer (CRC). Advances in surgical techniques and immunosuppressive medications have resulted in increased survival rates of both patients and grafts, but the incidence of CRC in the Irish renal transplant population is currently unknown. The aim of this study is to review the incidence of CRC in the Irish renal transplant population and compare it to the general population. METHODS A retrospective review of a prospectively maintained database of all renal transplant recipients in Ireland between January 1980 and July 2017 was performed. RESULTS Thirty-three out of 4230 transplant recipients (men = 20, women = 13) developed CRC subsequent to transplantation and were eligible for inclusion in the series. The mean age at transplantation was 51.5 years, with patients developing CRC on average 10.9 years post-transplantation; 6.1% (n = 2/33) had stage IV disease at diagnosis. The majority of patients (87.8%) had a pathologic T stage of T3/T4 and 45.5% had involvement of locoregional lymph nodes (N1/N2); 42.4% also had a mucinous component at histopathologic assessment. The incidence of CRC was higher in the transplant population compared to the general population. CONCLUSION This is the first population-based assessment of CRC development in the Irish renal transplant population. Our data suggest that Irish transplant recipients have an increased risk of being diagnosed with a more advanced tumor than the general population, with most being diagnosed almost a decade after transplantation. This highlights the need for increased awareness among patients and clinicians and the potential need for coordinated lifelong surveillance of this patient population to ensure early detection and treatment.
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Affiliation(s)
- A Balhareth
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - I S Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - J G Solon
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - E Gibbons Harte
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - F Boland
- Data Science Centre and HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
| | - J M O'Sullivan
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland
| | - J P Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Little
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland
| | - D A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
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114
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Lawrence S, Ismail F, Jamal SZ, Whalen MM. Tributyltin stimulates synthesis of interferon gamma and tumor necrosis factor alpha in human lymphocytes. J Appl Toxicol 2018; 38:1081-1090. [PMID: 29532501 PMCID: PMC5997500 DOI: 10.1002/jat.3617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 12/20/2022]
Abstract
Tributyltin (TBT) is found in human blood and other tissues and thus is of considerable concern as to its effects on human health. Previous studies have demonstrated that TBT has detrimental effects on immune function. Recently, we found that exposures to TBT caused increased secretion of two important proinflammatory cytokines, tumor necrosis factor alpha (TNFα) and interferon gamma (IFNγ). Elevation of either of these cytokines has the potential to cause chronic inflammation, which is an important factor in a number of diseases including cancer. The current study examined the mechanism of TBT-induced elevations of TNFα and IFNγ secretion and found that the p38 mitogen-activated protein kinase pathway was essential to the ability of TBT to stimulate secretion. Additionally, this study demonstrated that increased secretion of these cytokines was due to TBT-induced increases in their overall synthesis, rather than simply being due to an increase in the release of already formed proteins. The TBT-induced increases in synthesis were evident within 6 hours of exposure. The p38 mitogen-activated protein kinase pathway is also necessary for the TBT-induced increases in both TNFα and IFNγ synthesis. The role of increased transcription of TNFα and IFNγ mRNA in response to TBT exposures as a possible explanation for the increased synthesis of these cytokines was also examined. It was found that increased mRNA levels did not appear to explain fully the increases in either TNFα or IFNγ synthesis. Thus, TBT is able to increase secretion of two important proinflammatory cytokines by increasing their synthesis.
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Affiliation(s)
- Shanieek Lawrence
- Departments of Biological Sciences, Tennessee State University, Nashville, TN, 37209, USA
| | - Farah Ismail
- Departments of Chemistry, Tennessee State University, Nashville, TN, 37209, USA
| | - Sarah Z Jamal
- Departments of Chemistry, Tennessee State University, Nashville, TN, 37209, USA
| | - Margaret M Whalen
- Departments of Chemistry, Tennessee State University, Nashville, TN, 37209, USA
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115
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Bortolussi G, Muro AF. Advances in understanding disease mechanisms and potential treatments for Crigler–Najjar syndrome. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1495558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Giulia Bortolussi
- Mouse Molecular Genetics Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Andrés Fernando Muro
- Mouse Molecular Genetics Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
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116
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Palladini A, Landuzzi L, Lollini PL, Nanni P. Cancer immunoprevention: from mice to early clinical trials. BMC Immunol 2018; 19:16. [PMID: 29902992 PMCID: PMC6003025 DOI: 10.1186/s12865-018-0253-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 06/01/2018] [Indexed: 02/08/2023] Open
Abstract
Cancer immunoprevention is based on the fact that a functioning immune system controls tumor onset and development in humans and animals, thus leading to the idea that the enhancement of immune responses in healthy individuals could effectively reduce cancer risk later in life. Successful primary immunoprevention of tumors caused by hepatitis B and papilloma viruses is already implemented at the population level with specific vaccines. The immunoprevention of human tumors unrelated to infectious agents is an outstanding challenge. Proof-of-principle preclinical studies in genetically-modified or in carcinogen-exposed mice clearly demonstrated that vaccines and other immunological treatments induce host immune responses that effectively control tumor onset and progression, eventually resulting in cancer prevention. While a straightforward translation to healthy humans is currently unfeasible, a number of pioneering clinical trials showed that cancer immunoprevention can be effectively implemented in human cohorts affected by specific cancer risks, such as preneoplastic/early neoplastic lesions. Future developments will see the implementation of cancer immunoprevention in a wider range of conditions at risk of tumor development, such as the exposure to known carcinogens and genetic predispositions.
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Affiliation(s)
- Arianna Palladini
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Viale Filopanti 22, 40126, Bologna, Italy
| | - Lorena Landuzzi
- Laboratory of Experimental Oncology, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Pier-Luigi Lollini
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Viale Filopanti 22, 40126, Bologna, Italy.
| | - Patrizia Nanni
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Viale Filopanti 22, 40126, Bologna, Italy
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117
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Impaired Secretion of TNF-α by Monocytes Stimulated With EBV Peptides Associates With Infectious Complications After Kidney Transplantation. Transplantation 2018; 102:1005-1013. [DOI: 10.1097/tp.0000000000002133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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118
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Pleiotropic Effects of Risk Factors in Age-Related Macular Degeneration and Seemingly Unrelated Complex Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1074:247-255. [PMID: 29721950 DOI: 10.1007/978-3-319-75402-4_30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Age-related macular degeneration (AMD) is a complex disease with both environmental and genetic factors influencing disease risk. Genome-wide case-control association studies, candidate gene analyses, and epidemiological studies reinforced the notion that AMD is predominantly a disease of an impaired complement system and an altered high-density lipoprotein (HDL) metabolism. Recent reports demonstrated the pleiotropic role of the complement system and HDL in complex diseases such as cardiovascular disease, autoimmune disorders, cancer, and Alzheimer's disease. In light of these findings, we explore current evidence for a shared genetic and environmental risk of AMD and unrelated complex diseases based on epidemiological studies. Shared risk factors may indicate common pathways in disease pathology and thus may have implications for novel treatment options of AMD pathology.
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119
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Wolf S, Hoffmann VS, Habicht A, Kauke T, Bucher J, Schoenberg M, Werner J, Guba M, Andrassy J. Effects of mTOR-Is on malignancy and survival following renal transplantation: A systematic review and meta-analysis of randomized trials with a minimum follow-up of 24 months. PLoS One 2018; 13:e0194975. [PMID: 29659588 PMCID: PMC5901925 DOI: 10.1371/journal.pone.0194975] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/14/2018] [Indexed: 12/20/2022] Open
Abstract
Background mTOR-Is positively influence the occurrence and course of certain tumors after solid organ transplantation. The effect of mTOR-Is on the overall incidence of tumors irrespective of their origin is not entirely clear. Furthermore, conflicting data have been shown on mortality under mTOR-Is. Methods The current literature was searched for prospective randomized controlled renal transplantation trials. There were 1415 trials screened of which 13 could be included (pts. = 5924). A minimum follow-up of 24 months was mandatory for inclusion. Incidence of malignancies and patient survival was assessed in meta-analyses. Results The average follow-up of all trials was 40.6 months. Malignancy was significantly reduced under mTOR-Is compared to CNIs (RR 0.70, CI 0.49–0.99, p = 0.046). This effect remained stable when combined with CNIs (RR 0.58, CI 0.34–1.00, p = 0.05). When NMSCs were excluded the risk for malignancy remained significantly reduced under mTOR-I therapy (mono and combi) (RR 0.43, CI 0.24–0.77, p = 0.0046). Graft survival was minimally decreased under mTOR-Is (RR 0.99, CI 0.98–1.00, p = 0.054). This effect was abrogated when mTOR-Is were combined with CNIs (RR 0.99, CI 0.97–1.02, p = 0.50). Patient survival was not different (RR 1.00, CI 0.99–1.01, p = 0.54). Conclusions Posttransplant patients have a lower incidence of malignancy when treated with an mTOR-I no matter if it is used in combination with CNIs or not. This beneficial effect remains significant even when NMSCs are excluded. With currently used mTOR-I-based regimen patient and graft survival is not different compared to CNI therapies.
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Affiliation(s)
- Sebastian Wolf
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilian’s University, Munich, Germany
- Department of Visceral and Transplant Surgery, Augsburg Hospital, Augsburg, Germany
| | - Verena S. Hoffmann
- Institute of Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig-Maximilian’s-University, Munich, Germany
- Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
| | - Antje Habicht
- Transplant Center, University Hospital Grosshadern, Ludwig-Maximilian’s University, Munich, Germany
| | - Teresa Kauke
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilian’s University, Munich, Germany
| | - Julian Bucher
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilian’s University, Munich, Germany
| | - Markus Schoenberg
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilian’s University, Munich, Germany
| | - Jens Werner
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilian’s University, Munich, Germany
| | - Markus Guba
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilian’s University, Munich, Germany
| | - Joachim Andrassy
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilian’s University, Munich, Germany
- * E-mail:
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120
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Tsai HI, Lee CW, Kuo CF, See LC, Liu FC, Chiou MJ, Yu HP. De novo malignancy in organ transplant recipients in Taiwan: a nationwide cohort population study. Oncotarget 2018; 8:36685-36695. [PMID: 27821818 PMCID: PMC5482688 DOI: 10.18632/oncotarget.13124] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/28/2016] [Indexed: 12/31/2022] Open
Abstract
Organ transplant recipients appear to have a higher risk of de novo malignancy. The aim of the study was designed to estimate cancer risk in heart, lung, kidney and liver transplant recipients. The cohort study used the Taiwan National Health Insurance Research Database (1996-2011) and followed the outcomes of organ recipients until 2012. De novo cancer and mortality rates after organ transplantation were evaluated using standardized incidence ratios, excess absolute risks of cancer, and standardized mortality ratios in recipients were compared with those in the general population. We identified 40, 231, 2, and 115 patients who developed cancer after heart, kidney, lung, and liver transplantation, which corresponded to a cancer incidence of 878.4, 1101.2, 728.9, and 1361.4 cases per 100,000 person-years, respectively. In heart, kidney, lung, and liver recipients, the overall standardized incidence ratios were 1.65 (1.21-2.24), 3.33 (2.93-3.79), 1.82 (0.45-7.27) and 3.37 (2.81-4.05) and the overall standardized mortality ratios were 5.45 (4.96-5.98), 1.47 (1.34-1.61), 8.92 (7.10-11.20), and 3.83 (3.48-4.20), respectively. These results reveal a three-fold increase in de novo cancer risk in organ transplant patients compared with the general population. This study illustrated the importance of de novo malignancy after organ transplantation.
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Affiliation(s)
- Hsin-I Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Wei Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Surgery, Change Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lai-Chu See
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Chao Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Jiun Chiou
- Office for Big Data Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huang-Ping Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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121
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Solid Organ Cancer and Melanoma in Kidney Transplant Recipients: TumorTx Base Preliminary Results. Transplant Proc 2018; 50:1881-1888. [PMID: 30056921 DOI: 10.1016/j.transproceed.2018.02.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Incidence of malignancy in transplant recipients is higher than in the general population. Malignancy is a major cause of mortality following solid organ transplantation and a major barrier to long-term survival for the kidney. The aim of this study was to estimate the incidence of solid organ malignancy (SOM) and melanoma in renal transplant recipients (RTR) transplanted at 2 representative transplant centers in Poland based on data from the Polish Tumor Registry. MATERIAL AND METHODS We analyzed the medical data of 3069 patients who underwent kidney transplantation (KTx) between 1995 and 2015. RESULTS In our study 112 SOM (3.6%) were diagnosed. The majority of patients were male (n = 71; 63.4%; P < .01). The mean age at KTx was 48.0 ± 13.1 years and the mean age at the time of cancer diagnosis was 55.9 ± 12.7 years. The average time of malignancy occurrence was 5.9 ± 5.0 years after KTx. SOM was the cause of death in 60 patients (53%). The most common were malignancies of gastrointestinal tract (25%), urinary tract tumors (23.2%), lung cancer (n = 18; 16%), and lymphoma (13.4%). We found an increase in the percentage of chronic glomerular nephropathy in the group of SOM (n = 56; 50%) compared with renal insufficiency of other etiologies. CONCLUSIONS RTR in Poland are at a significant risk of malignancy development in a variety of organs, primarily urinary tract tumors and lymphoma. Cancers most frequently occurring in the general population such as lung and colorectal cancer are common in our RTR. On this basis an appropriate tumor screening schedule can be developed in individual countries.
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122
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Dharnidharka VR. Comprehensive review of post-organ transplant hematologic cancers. Am J Transplant 2018; 18:537-549. [PMID: 29178667 DOI: 10.1111/ajt.14603] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 01/25/2023]
Abstract
A higher risk for a variety of cancers is among the major complications of posttransplantation immunosuppression. In this part of a continuing series on cancers posttransplantation, this review focuses on the hematologic cancers after solid organ transplantation. Posttransplantation lymphoproliferative disorders (PTLDs), which comprise the great majority of hematologic cancers, represent a spectrum of conditions that include, but are not limited to, the Hodgkin and non-Hodgkin lymphomas. The oncogenic Epstein-Barr virus is a key pathogenic driver in many PTLD cases, through known and unknown mechanisms. The other hematologic cancers include leukemias and plasma cell neoplasms (multiple myeloma and plasmacytoma). Clinical features vary across malignancies and location. Preventive screening strategies have been attempted mainly for PTLDs. Treatments include the chemotherapy regimens for the specific cancers, but also include reduction of immunosuppression, rituximab, and other therapies.
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Affiliation(s)
- Vikas R Dharnidharka
- Division of Pediatric Nephrology, Washington University School of Medicine, Saint Louis, MO, USA
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123
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Borgogna C, Olivero C, Lanfredini S, Calati F, De Andrea M, Zavattaro E, Savoia P, Trisolini E, Boldorini R, Patel GK, Gariglio M. β-HPV Infection Correlates with Early Stages of Carcinogenesis in Skin Tumors and Patient-Derived Xenografts from a Kidney Transplant Recipient Cohort. Front Microbiol 2018; 9:117. [PMID: 29459852 PMCID: PMC5807414 DOI: 10.3389/fmicb.2018.00117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/18/2018] [Indexed: 11/15/2022] Open
Abstract
Many malignancies that occur in high excess in kidney transplant recipients (KTRs) are due to viruses that thrive in the setting of immunosuppression. Keratinocyte carcinoma (KC), the most frequently occurring cancer type in KTR, has been associated with skin infection by human papillomavirus (HPV) from the beta genus. In this report, we extend our previous investigation aimed at identifying the presence of active β-HPV infection in skin tumors from KTRs through detection of viral protein expression. Using a combination of antibodies raised against the E4 and L1 proteins of the β-genotypes, we were able to visualize infection in five tumors [one keratoacanthoma (KA), three actinic keratoses (AKs), and one seborrheic keratoses (SKs)] that were all removed from two patients who had been both transplanted twice, had developed multiple KCs, and presented with a long history of immunosuppression (>30 years). These infected tissues displayed intraepidermal hyperplasia and increased expression of the ΔNp63 protein, which extended into the upper epithelial layers. In addition, using a xenograft model system in nude mice displaying a humanized stromal bed in the site of grafting, we successfully engrafted three AKs, two of which were derived from the aforementioned KTRs and displayed β-HPV infection in the original tumor. Of note, one AK-derived xenograft, along with its ensuing lymph node metastasis, was diagnosed as squamous cell carcinoma (SCC). In the latter, both β-HPV infection and ΔNp63 expression were no longer detectable. Although the overall success rate of engrafting was very low, the results of this study show for the first time that β-HPV+ and ΔNp63+ intraepidermal hyperplasia can indeed progress to an aggressive SCC able to metastasize. Consistent with a series of reports attributing a causative role of β-HPV at early stages of skin carcinogenesis through ΔNp63 induction and increased keratinocytes stemness, here we provide in vivo evidence that these events are also occurring in the affected skin of KTRs. Due to these β-HPV-driven molecular pathways, the nascent tumor cell is able to acquire a high enough number of carcinogenic insults that its proliferation and survival will eventually become independent of viral gene expression.
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Affiliation(s)
- Cinzia Borgogna
- Virology Unit, Department of Translational Medicine, Novara Medical School, University of Eastern Piedmont, Novara, Italy
| | - Carlotta Olivero
- Virology Unit, Department of Translational Medicine, Novara Medical School, University of Eastern Piedmont, Novara, Italy.,School of Biosciences, European Cancer Stem Cell Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Simone Lanfredini
- School of Biosciences, European Cancer Stem Cell Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Federica Calati
- Virology Unit, Department of Translational Medicine, Novara Medical School, University of Eastern Piedmont, Novara, Italy
| | - Marco De Andrea
- Virology Unit, Department of Translational Medicine, Novara Medical School, University of Eastern Piedmont, Novara, Italy.,Virology Unit, Department of Public Health and Pediatric Sciences, Turin Medical School, University of Turin, Turin, Italy
| | - Elisa Zavattaro
- Dermatology Unit, Department of Health Sciences, Novara Medical School, Novara, Italy
| | - Paola Savoia
- Dermatology Unit, Department of Health Sciences, Novara Medical School, Novara, Italy
| | - Elena Trisolini
- Pathology Unit, Department of Health Sciences, Novara Medical School, Novara, Italy
| | - Renzo Boldorini
- Pathology Unit, Department of Health Sciences, Novara Medical School, Novara, Italy
| | - Girish K Patel
- School of Biosciences, European Cancer Stem Cell Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Marisa Gariglio
- Virology Unit, Department of Translational Medicine, Novara Medical School, University of Eastern Piedmont, Novara, Italy
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124
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Müller DC, Rämö M, Naegele K, Ribi S, Wetterauer C, Perrina V, Quagliata L, Vlajnic T, Ruiz C, Balitzki B, Grobholz R, Gosert R, Ajuh ET, Hirsch HH, Bubendorf L, Rentsch CA. Donor-derived, metastatic urothelial cancer after kidney transplantation associated with a potentially oncogenic BK polyomavirus. J Pathol 2018; 244:265-270. [DOI: 10.1002/path.5012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 11/20/2017] [Accepted: 11/24/2017] [Indexed: 01/30/2023]
Affiliation(s)
- David C Müller
- Department of Urology; University Hospital Basel, University of Basel; Basel Switzerland
- Institute for Pathology; University Hospital Basel, University of Basel; Basel Switzerland
| | - Maarit Rämö
- Department of Urology; University Hospital Basel, University of Basel; Basel Switzerland
- Institute for Pathology; University Hospital Basel, University of Basel; Basel Switzerland
| | - Klaudia Naegele
- Division of Infection Diagnostics, Department of Biomedicine; University of Basel; Basel Switzerland
| | - Sebastian Ribi
- Institute for Pathology; University Hospital Basel, University of Basel; Basel Switzerland
| | - Christian Wetterauer
- Department of Urology; University Hospital Basel, University of Basel; Basel Switzerland
| | - Valeria Perrina
- Institute for Pathology; University Hospital Basel, University of Basel; Basel Switzerland
| | - Luca Quagliata
- Institute for Pathology; University Hospital Basel, University of Basel; Basel Switzerland
| | - Tatjana Vlajnic
- Institute for Pathology; University Hospital Basel, University of Basel; Basel Switzerland
| | - Christian Ruiz
- Institute for Pathology; University Hospital Basel, University of Basel; Basel Switzerland
| | - Beate Balitzki
- Institute of Forensic Medicine; University of Basel; Basel Switzerland
| | | | - Rainer Gosert
- Division of Infection Diagnostics, Department of Biomedicine; University of Basel; Basel Switzerland
| | - Elvis T Ajuh
- Transplantation & Clinical Virology, Department of Biomedicine; University of Basel; Basel Switzerland
| | - Hans H Hirsch
- Division of Infection Diagnostics, Department of Biomedicine; University of Basel; Basel Switzerland
- Transplantation & Clinical Virology, Department of Biomedicine; University of Basel; Basel Switzerland
| | - Lukas Bubendorf
- Institute for Pathology; University Hospital Basel, University of Basel; Basel Switzerland
| | - Cyrill A Rentsch
- Department of Urology; University Hospital Basel, University of Basel; Basel Switzerland
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125
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The Rapid Development of Squamous Cell Carcinoma on the Nasal Dorsum of a Patient Receiving Immunosuppressive Therapy. J Craniofac Surg 2018; 28:e277-e279. [PMID: 28468221 DOI: 10.1097/scs.0000000000003548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The risk of cancer is significantly increased in patients undergoing renal transplant surgery than in the general population. In particular, skin cancer is the most commonly occurring cancer in these patients.A 34-year-old man underwent living renal transplantation for focal segmental glomerulosclerosis. After 18 months, he developed a lesion on the nasal dorsum, approximately 1 cm in size, and the lesion rapidly expanded to cover the entire dorsum.Owing to its rapid expansion, the lesion was suspected to be a malignant tumor and wide excision was planned.We removed the lesion with a 6-mm margin. Squamous cell carcinoma was diagnosed through intraoperative rapid pathological examination. The nasal bone and septum were invaded by the tumor and, as a result, the entire external nose was removed. The patient's nose was subsequently reconstructed using a free forearm flap for lining, iliac bone graft for the nasal frame, and a scalping forehead flap for skin coverage.Selective target radiotherapy was administered at the closest margin around the lesion, and the dosage of immunosuppressants was reduced.At >2 years postoperatively, the patient showed good cosmetic results with no relapse or metastasis of the tumor.We report the unusual case of a young man who developed a rapidly progressing squamous cell carcinoma on his nasal dorsum after 18 months of immunosuppression. Squamous cell carcinoma in organ transplant recipients may be more aggressive and may progress differently than in regular patients. Therefore, special attention is required for patients who take immunosuppressive drugs after renal transplant surgery.
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Yasmin S, Whalen M. Flame retardants, hexabromocyclododecane (HCBD) and tetrabromobisphenol a (TBBPA), alter secretion of tumor necrosis factor alpha (TNFα) from human immune cells. Arch Toxicol 2018; 92:1483-1494. [PMID: 29356862 DOI: 10.1007/s00204-018-2156-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/17/2018] [Indexed: 12/15/2022]
Abstract
Hexabromocyclododecane (HBCD) and tetrabromobisphenol A (TBBPA) are flame retardants, used in a variety of applications, which contaminate the environment and are found in human blood. HBCD and TBBPA have been shown to alter the tumor killing function of natural killer (NK) lymphocytes and the secretion of the inflammatory cytokines interferon gamma (IFNγ) and interleukin 1 beta (IL-1β). The current study examined the effects of HBCD and TBBPA on secretion of the critical pro-inflammatory cytokine tumor necrosis factor alpha (TNFα) from human immune cells. Preparations of human immune cells that ranged in complexity were studied to determine if the effects of the compounds were consistent as the composition of the cell preparation became more heterogeneous. Cell preparations studied were: NK cells, monocyte-depleted (MD) peripheral blood mononuclear cells (PBMCs), and PBMCs. Exposure of NK cells to higher concentrations of HBCD (5 and 2.5 µM) caused decreased secretion of TNFα. However, when the cell preparation contained T lymphocytes (MD-PBMCs and PBMCs) these same concentrations of HBCD increased TNFα secretion as did nearly all other concentrations. This suggests that HBCD's ability to increase TNFα secretion from immune cells was dependent on the presence of T lymphocytes. In contrast, exposures to TBBPA decreased the secretion of TNFα from all immune cell preparations regardless of the composition of the cell preparation. Further, HBCD-induced increases in TNFα secretion utilized the p38 MARK pathway. Thus, both HBCD and TBBPA may have the capacity to disrupt the inflammatory response with HBCD having the potential to cause chronic inflammation.
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Affiliation(s)
- Sharia Yasmin
- Departments of Biological Sciences, Tennessee State University, Nashville, TN, 37209, USA
| | - Margaret Whalen
- Departments of Chemistry, Tennessee State University, Nashville, TN, 37209, USA.
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Abstract
Epidermal cancers include keratinocyte cancer, melanocyte cancer, and Merkel cell carcinoma. These cancers account for the vast majority of new cancers diagnosed in Australia, North America, and Europe. Keratinocyte cancer is the most common epidermal cancer and accounts for 7 out of 8 new cancers diagnosed in Australia. Melanoma and Merkel cell carcinoma are less common than keratinocyte carcinoma but are more important causes of mortality in Australia. Keratinocyte cancer has also been demonstrated to be a marker of cancer-prone phenotype. Risk factors for epidermal cancer include intrinsic and environmental factors, in particular exposure to ultraviolet radiation and advanced age. Actinic keratosis has an approximate prevalence of 79% of men and 68% of women between 60 and 69 years of age, and has a low risk of malignant transformation into squamous cell carcinoma. Basal cell carcinoma is the most common malignancy in Caucasians worldwide, with the incidence increasing by 2% per year in Australia. Squamous cell carcinoma is the second most common epidermal cancer, with an incidence of approximately 1035 or 472 per 100,000 person-years in men and women, respectively. Primary risk factors for both basal cell carcinoma and squamous cell carcinoma include light skin color, UV radiation exposure, and chronic immunosuppression. Although the rate of melanoma is increasing, the mortality in Australia is reducing and is currently 9%. The overall incidence of melanoma in Australia is approximately 50 cases per 100,000 persons (62 for men and 40 for women). Keratinocyte carcinoma and melanoma are risk factors for developing further skin cancer and primary malignancy. This contribution reviews the incidence, prevalence, and risk factors associated with the development of epidermal cancer and premalignant epidermal neoplasia.
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128
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Ai R, Tao Y, Hao Y, Jiang L, Dan H, Ji N, Zeng X, Zhou Y, Chen Q. Microenvironmental regulation of the progression of oral potentially malignant disorders towards malignancy. Oncotarget 2017; 8:81617-81635. [PMID: 29113419 PMCID: PMC5655314 DOI: 10.18632/oncotarget.20312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/04/2017] [Indexed: 02/05/2023] Open
Abstract
Oral potentially malignant disorders (OPMD) develop in a complex tissue microenvironment where they grow sustainably, acquiring oral squamous cell carcinoma (OSCC) characteristics. The malignant tumor depends on interactions with the surrounding microenvironment to achieve loco-regional invasion and distant metastases. Unlike abnormal cells, the multiple cell types in the tissue microenvironment are relatively stable at the genomic level and, thus, become therapeutic targets with lower risk of resistance, decreasing the risk of OPMD acquiring cancer characteristics and carcinoma recurrence. However, deciding how to disrupt the OPMD and OSCC microenvironments is itself a daunting challenge, since their microenvironments present opposite capacities, resulting in diverse consequences. Furthermore, recent studies revealed that tumor-associated immune cells also participate in the process of differentiation from OPMD to OSCC, suggesting that reeducating stromal cells may be a new strategy to prevent OPMD from acquiring OSCC characteristics and to treat OSCC. In this review, we discuss the characteristics of the microenvironment of OPMD and OSCC as well as new therapeutic strategies.
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Affiliation(s)
- Ruixue Ai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yan Tao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yilong Hao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ning Ji
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine of West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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129
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Dahlberg S, Ede J, Schött U. Vitamin K and cancer. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:555-567. [PMID: 28933567 DOI: 10.1080/00365513.2017.1379090] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Subclinical vitamin K deficits refer to carboxylation defects of different types of vitamin K-dependent hepatic and extrahepatic so-called Gla proteins without prolongation of the prothrombin time. This condition has been reported in different clinical situations due to insufficient supply or malabsorption of vitamin K as well as drug interactions. This review discusses the effects of different vitamin K subspecies on tumour growth and the possible anti-tumour effects of increased vitamin K intake. Blocking carboxylation of vitamin K-dependent proteins with warfarin anticoagulation - what are the risks/benefits for carcinogenesis? Previous studies on both heparin and low molecular weight heparin blocking of the vitamin K-dependent factors X and II have shown tumour suppressive effects. Vitamin K has anti-inflammatory effects that could also impact carcinogenesis, but little data exists on this subject.
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Affiliation(s)
- Sofia Dahlberg
- a Department of Anaesthesia and Intensive Care, Institution of Clinical Science Lund, Medical Faculty , Lund University , Lund , Sweden
| | - Jacob Ede
- a Department of Anaesthesia and Intensive Care, Institution of Clinical Science Lund, Medical Faculty , Lund University , Lund , Sweden
| | - Ulf Schött
- a Department of Anaesthesia and Intensive Care, Institution of Clinical Science Lund, Medical Faculty , Lund University , Lund , Sweden.,b Department of Anaesthesia and Intensive Care , Skåne University Hospital Lund , Lund , Sweden
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130
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Garritsen FM, Verheijen RHM, Gerestein CG, van Zuilen AD, Oosterhaven JAF, van Dijk M, Bruijnzeel-Koomen CAF, Schuttelaar ML, de Bruin-Weller MS. Is there an increased risk of cervical neoplasia in atopic dermatitis patients treated with oral immunosuppressive drugs? J Eur Acad Dermatol Venereol 2017; 32:271-275. [PMID: 28925576 DOI: 10.1111/jdv.14593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral immunosuppressive drugs are frequently prescribed in young women with atopic dermatitis (AD). Immunocompromised patients may have a higher risk of developing high-risk HPV infections, cervical intra-epithelial neoplasia (CIN) and cervical carcinoma. Most literature on patients using oral immunosuppressive drugs is available in organ transplant patients. Literature on the risk of developing cervical carcinoma in AD patients treated with oral immunosuppressive drugs is lacking. At this moment, there is no clear guideline/consensus on this topic, but in daily practice, questions arise concerning whether this risk is increased and whether more intensive screening in women using immunosuppressive drugs should take place. OBJECTIVE To investigate the occurrence of cervical carcinoma in women with AD treated with oral immunosuppressive drugs. METHODS In this retrospective cohort study in two university medical centres in the Netherlands, all female adult AD patients receiving oral immunosuppressive drugs (cyclosporine A, azathioprine, methotrexate, mycophenolate mofetil, enteric-coated mycophenolate sodium and extended release tacrolimus) for more than 2 months between 1989 and 1 January 2014 were included. Patient files in the national histopathology register were screened for PAP3a, CIN I, CIN II, CIN III and cervical carcinoma. RESULTS A total of 257 female AD patients with one or more treatment episodes from 1989 until 1 January 2014 were identified and included in this study. In 189 patients (73.5%), results of cervical examination were reported in the national histopathology database. Median total duration of treatment in these 189 women was 407.0 days (IQR 243.0-940.0). No cervical carcinoma during or following immunosuppressive therapy was found in our patient group. CONCLUSIONS No intensified screening programme for cervical neoplasia seems necessary for women with AD using oral immunosuppressive drugs.
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Affiliation(s)
- F M Garritsen
- Department of Dermatology, University Medical Center, Utrecht, The Netherlands
| | - R H M Verheijen
- Department of Gynaecological Oncology, University Medical Center, Utrecht, The Netherlands
| | - C G Gerestein
- Department of Gynaecological Oncology, University Medical Center, Utrecht, The Netherlands
| | - A D van Zuilen
- Department of Nefrology, University Medical Center, Utrecht, The Netherlands
| | - J A F Oosterhaven
- Department of Dermatology, University Medical Center, Groningen, The Netherlands
| | - M van Dijk
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | | | - M L Schuttelaar
- Department of Dermatology, University Medical Center, Groningen, The Netherlands
| | - M S de Bruin-Weller
- Department of Dermatology, University Medical Center, Utrecht, The Netherlands
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131
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Arroyo Mühr LS, Bzhalava Z, Hortlund M, Lagheden C, Nordqvist Kleppe S, Bzhalava D, Hultin E, Dillner J. Viruses in cancers among the immunosuppressed. Int J Cancer 2017; 141:2498-2504. [DOI: 10.1002/ijc.31017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/17/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Laila Sara Arroyo Mühr
- Karolinska Institutet; Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital; Huddinge Stockholm 141 86 Sweden
| | - Zurab Bzhalava
- Karolinska Institutet; Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital; Huddinge Stockholm 141 86 Sweden
| | - Maria Hortlund
- Karolinska Institutet; Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital; Huddinge Stockholm 141 86 Sweden
| | - Camilla Lagheden
- Karolinska Institutet; Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital; Huddinge Stockholm 141 86 Sweden
| | - Sara Nordqvist Kleppe
- Karolinska Institutet; Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital; Huddinge Stockholm 141 86 Sweden
| | - Davit Bzhalava
- Karolinska Institutet; Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital; Huddinge Stockholm 141 86 Sweden
| | - Emilie Hultin
- Karolinska Institutet; Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital; Huddinge Stockholm 141 86 Sweden
| | - Joakim Dillner
- Karolinska Institutet; Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital; Huddinge Stockholm 141 86 Sweden
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Peterson JJ, Steele-Moses SK. Update on New Therapies With Immune Checkpoint Inhibitors. Clin J Oncol Nurs 2017; 20:405-10. [PMID: 27441513 DOI: 10.1188/16.cjon.405-410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Immunotherapy has had a long history in cancer treatment and, with recent breakthroughs, new drugs are available that have shown promising results. OBJECTIVES The current article discusses an overview of immune function, including immunoediting and the theory of immune checkpoints, as well as specific drugs that have been approved as immune checkpoint inhibitors. Additional discussion includes a review of nursing implications and administration, side effects, adverse events, and the future of immuno-oncology. METHODS This review of literature focused on locating, summarizing, and synthesizing data from published articles, the American Cancer Society, U.S. Food and Drug Administration, and literature from pharmaceutical manufacturers that focused on immunotherapy treatment options that use checkpoint inhibition. Search criteria included articles published from 2005-2015 and archived in CINAHL®, OVID®, and PubMed databases using the key words immunotherapy, immune checkpoint inhibition, PD-1, PD-L1, CTLA-4, and oncology. FINDINGS Cancer therapy targeting immune checkpoint inhibition has shown promising results and continues to evolve. Oncology nurses need to remain abreast of new immune-modulating therapies to understand their efficacy, as well as side effect management.
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133
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Polyomavirus Replication and Smoking Are Independent Risk Factors for Bladder Cancer After Renal Transplantation. Transplantation 2017; 101:1488-1494. [PMID: 27232933 DOI: 10.1097/tp.0000000000001260] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Solid organ transplant recipients are at increased risk for developing malignancies. Polyomaviruses (PV) have been historically associated with experimental tumor development and recently described in association with renourinary malignancies in transplant patients. The aim of this study was to investigate the relationship between PV replication and smoking, and the development of malignant neoplasms in kidney transplant recipients. METHODS A retrospective case-control study was conducted for PV replication in all kidney biopsies and urine cytologies performed between 1998 and 2014 from kidney transplant recipients at the University of Maryland Medical Center. Polyomavirus-positive patients (n = 943) were defined as having any of the following: a kidney biopsy with PV associated nephropathy, any urine cytology demonstrating "decoy" cells, and/or significant polyomavirus BK viremia. Polyomavirus-negative matched patients (n = 943) were defined as lacking any evidence of PV replication. The incidence of malignancy (excluding nonmelanoma skin tumors) was determined in these 1886 patients and correlated with demographic data and history of smoking. RESULTS There was a 7.9% incidence of malignant tumors after a mean posttransplant follow-up of 7.9 ± 5.4 years. Among all cancer subtypes, only bladder carcinoma was significantly associated with PV replication. By multivariate analysis, only PV replication and smoking independently increased the risk of bladder cancer, relative risk, 11.7 (P = 0.0013) and 5.6 (P = 0.0053), respectively. CONCLUSIONS The findings in the current study indicate that kidney transplant recipients with PV replication and smoking are at particular risk to develop bladder carcinomas and support the need for long-term cancer surveillance in these patients.
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Zamoiski RD, Yanik E, Gibson TM, Cahoon EK, Madeleine MM, Lynch CF, Gustafson S, Goodman MT, Skeans M, Israni AK, Engels EA, Morton LM. Risk of Second Malignancies in Solid Organ Transplant Recipients Who Develop Keratinocyte Cancers. Cancer Res 2017; 77:4196-4203. [PMID: 28615224 PMCID: PMC5540772 DOI: 10.1158/0008-5472.can-16-3291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/06/2017] [Accepted: 06/05/2017] [Indexed: 01/07/2023]
Abstract
Solid organ transplant recipients have increased risk for developing keratinocyte cancers, including cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), in part as a result of immunosuppressive medications administered to prevent graft rejection. In the general population, keratinocyte cancers are associated with increased risks of subsequent malignancy, however, the risk in organ transplant populations has not been evaluated. We addressed this question by linking the U.S. Scientific Registry of Transplant Recipients, which includes data on keratinocyte cancer occurrence, with 15 state cancer registries. Risk of developing malignancies after keratinocyte cancer was assessed among 118,440 Caucasian solid organ transplant recipients using multivariate Cox regression models. Cutaneous SCC occurrence (n = 6,169) was associated with 1.44-fold increased risk [95% confidence interval (CI), 1.31-1.59] for developing later malignancies. Risks were particularly elevated for non-cutaneous SCC, including those of the oral cavity/pharynx (HR, 5.60; 95% CI, 4.18-7.50) and lung (HR, 1.66; 95% CI, 1.16-2.31). Cutaneous SCC was also associated with increased risk of human papillomavirus-related cancers, including anal cancer (HR, 2.77; 95% CI, 1.29-5.96) and female genital cancers (HR, 3.43; 95% CI, 1.44-8.19). In contrast, BCC (n = 3,669) was not associated with overall risk of later malignancy (HR, 0.98; 95% CI, 0.87-1.12), including any SCC. Our results suggest that transplant recipients with cutaneous SCC, but not BCC, have an increased risk of developing other SCC. These findings somewhat differ from those for the general population and suggest a shared etiology for cutaneous SCC and other SCC in the setting of immunosuppression. Cutaneous SCC occurrence after transplantation could serve as a marker for elevated malignancy risk. Cancer Res; 77(15); 4196-203. ©2017 AACR.
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Affiliation(s)
- Rachel D Zamoiski
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Elizabeth Yanik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Elizabeth K Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Margaret M Madeleine
- Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Sally Gustafson
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Marc T Goodman
- Cancer Prevention and Control Program, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Melissa Skeans
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Ajay K Israni
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland.
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de Oliveira Martins CA, Do Val Guimarães ICC, Velarde LGC. Relationship between the risk factors for human papillomavirus infection and lower genital tract precursor lesion and cancer development in female transplant recipients. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
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Ugalde-Altamirano J, Álvarez Villegas D, Revuelta I, Coloma A, Torregrosa JV. Relationship Between Vitamin D Blood Levels and Cancer Development in Renal Transplant Patients: A Case-Control Study. Transplant Proc 2017; 48:2959-2961. [PMID: 27932118 DOI: 10.1016/j.transproceed.2016.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/19/2016] [Accepted: 09/02/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malignancy is one of the most common long-term complications in renal transplant patients, often related to immunosuppressive treatment although other factors could be considered. Vitamin D plays an important role in reducing cancer risk. After kidney transplantation (KT), 25-hydroxyvitamin D (25OH-D, or calcidiol) insufficiency concerns >85%. The main aim of the present study was to determine the relationship between calcidiol blood levels and cancer development in KT recipients. METHODS This was a retrospective observational case-control study including patients who received transplants in our hospital from 2003 to 2009 with a follow-up period to 2015. A total of 738 patients were included; 94 of them developed malignancy process, 80 of whose tumor data were analyzed in the cancer group, and the rest composed the control group. At the moment of cancer presentation, age, sex, primary kidney disease, time after surgery, immunosuppressant schedule, and 25OH-D blood levels were collected. RESULTS The mean patient age was 57 years. The percentages of man and women were 59.5% and 41.5%. The predominant etiology of kidney disease was chronic glomerulonephritis in 31.9%. There were no significant differences between sex, primary kidney disease, immunosuppressant schedule, or incidence of neoplasm in each group of patients. There were no significant differences in 25OH-D blood levels. The incidence of cancer was 7.1%-13.7% per year. The mean time between the graft surgery and the event was 5.6 years. CONCLUSIONS In patients with functioning KT, we found no correlation between blood levels of calcidiol and the incidence of cancer.
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Affiliation(s)
- J Ugalde-Altamirano
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
| | - D Álvarez Villegas
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - I Revuelta
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Coloma
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J-V Torregrosa
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
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137
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Late Persistent Positive EBV Viral Load and Risk of Solid Cancer in Kidney Transplant Patients. Transplantation 2017; 101:1473-1478. [DOI: 10.1097/tp.0000000000001280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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138
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High Posttransplant Cancer Incidence in Renal Transplanted Patients With Pretransplant Cancer. Transplantation 2017; 101:1295-1302. [DOI: 10.1097/tp.0000000000001225] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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139
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Abstract
Malignancy is the second most common single cause of death observed in organ transplant recipients. The excess cancer risk is related to intensity and duration of immunosuppressive therapy and inversely to recipient age. Immunodeficiency and (chronic/oncogenic) viral infections together constitute a major risk. Nonmelanoma skin cancer, Kaposi sarcoma, and posttransplant lymphoproliferative disease have standardized incidence ratios exceeding 10- or 50-fold. The mammalian target of rapamycin (mTOR) inhibitors, sirolimus and everolimus, are increasingly used after organ transplantation with potential advantages in virus-associated posttransplant malignancies as well as anti-cancer properties. Despite a seemingly clear mechanism of action and solid rationale for their use in cancer therapy, mTORis have met only modest success rates in clinical trials with advanced malignancies except for specific tumors, such as Kaposi sarcoma and mantle cell lymphoma. Because mTORis are primarily cytostatic, not cytotoxic, the observed clinical efficacy is a reflection of disease stabilization rather than tumor regression. Nonmelanoma skin cancers, in particular cutaneous squamous cell carcinoma, have the highest standardized incidence ratios in transplant recipients. Recent meta-analyses and randomized trials on secondary prevention of squamous cell carcinoma observed a reduction in cumulative tumor load, suggesting most benefit to be gained by early conversion to an mTOR inhibitor-based maintenance regime. There is ongoing debate on the mechanisms involved including withdrawal of the carcinogenic effects of calcineurin inhibitors and/or their impact on chronic (oncogenic) viral infections. At present, there is, however, insufficient evidence for the primary use of mTORis as protective agents against most other cancer types.
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Hortlund M, Arroyo Mühr LS, Storm H, Engholm G, Dillner J, Bzhalava D. Cancer risks after solid organ transplantation and after long-term dialysis. Int J Cancer 2017; 140:1091-1101. [PMID: 27870055 DOI: 10.1002/ijc.30531] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/18/2016] [Accepted: 10/26/2016] [Indexed: 02/04/2023]
Abstract
Immunosuppression involves an inability to control virus infections and increased incidence of virus-associated cancers. Some cancers without known viral etiology are also increased, but data on exactly which cancer forms are increased has been inconsistent. To provide a reliable and generalizable estimate, with high statistical power and long follow-up time, we assessed cancer risks using comprehensive, population-based registries in two different countries and from two different immunosuppressed patient groups (solid organ transplant recipients (OTRs) and long-term dialysis patients (LDPs)). National registries in Denmark and Sweden identified 20,804 OTRs and 31,140 LDPs that were followed up using national cancer registries. Standardized incidence ratios (SIR) compared to the general population were estimated. We found highly similar results, both for the two different countries and for the two different immunosuppressed cohorts, namely an increased incidence for the following specific cancer forms: Non-melanoma skin cancer (NMSC), non-Hodgkin's lymphoma and cancers of the lip, kidney, larynx and thyroid. The SIR for overall cancer among OTRs was 3.5 [n = 2,142, 95% CI, 3.4-3.7] in Sweden, 2.9 [n = 1,110, 95% CI, 2.8-3.1] in Denmark and 1.6 [n = 1,713, 95% CI, 1.5-1.6] among LDP. The SIR for NMSC among OTRs was 44.7 [n = 994, 95% CI, 42-47.5] in Sweden and 41.5 [n = 445, 95% CI, 37.8-45.5] in Denmark. The increased SIR for NMSC among LDPs was 5.3 [n = 304, 95% CI, 4.7-5.9]). In summary, an increased SIR for a specific, similar set of cancer forms is consistently found among the immunosuppressed. Conceivable explanations include surveillance bias and immunosuppression-related susceptibility to viral infections.
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Affiliation(s)
- Maria Hortlund
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Hans Storm
- Department of Prevention & Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - Gerda Engholm
- Department of Prevention & Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Davit Bzhalava
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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141
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Singh SK, Dorak MT. Cancer Immunoprevention and Public Health. Front Public Health 2017; 5:101. [PMID: 28534024 PMCID: PMC5421153 DOI: 10.3389/fpubh.2017.00101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/18/2017] [Indexed: 12/17/2022] Open
Abstract
The power of cancer immune surveillance has been documented beyond doubt, and the successful exploitation of immune response to cancer has started a new era in the war against cancer. Cancer biologists have recognized immunoevasion as an emerging hallmark in addition to the six hallmarks of cancer. Besides the natural connection between the immune system and cancer development, most established environmental risk factors are now known to interfere with immune surveillance mechanisms. Genetic variations regulating immunity may also modulate cancer susceptibility, but evidence for this is currently limited. Molecular cross talk linking “immune” and “genomic” surveillance pathways has been characterized. It appears that immune mechanisms may contribute to the effects of common cancer risk factors. We provide an updated overview of evidence for cancer immune surveillance, cancer risk factors interfering with it, and interventions to enhance cancer immune surveillance as tools to complement ongoing vaccine development efforts for cancer immunoprevention. Although there is a lot of support for cancer immunoprevention with simple lifestyle modifications from observational studies, there is an urgent need for clinical trials to establish the effectiveness of this approach for public health benefits.
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Affiliation(s)
- Sandeep K Singh
- Department of Biological Sciences, Florida International University, Miami, FL, USA
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142
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Borst AJ, Wechsler DS. Transplanting One Problem for Another. Pediatrics 2017; 139:peds.2017-0542. [PMID: 28557771 PMCID: PMC5841458 DOI: 10.1542/peds.2017-0542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alexandra J. Borst
- Pediatric Hematology-Oncology, Duke University Medical Center, Durham, North Carolina
| | - Daniel S. Wechsler
- Address correspondence to Daniel S. Wechsler, MD, PhD, Pediatric Hematology-Oncology, Duke University Medical Center, 397 Hanes House, DUMC Box 102382, Durham, NC 27710. E-mail:
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143
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Georgieva LA, Gielis EM, Hellemans R, Van Craenenbroeck AH, Couttenye MM, Abramowicz D, Van Beeumen G, Siozopoulou V, Van Rosmalen M, Bracke B, Hartman V, De Greef K, Roeyen G, Chapelle T, Ysebaert D, Bosmans JL. Single-Center Case Series of Donor-Related Malignancies: Rare Cases With Tremendous Impact. Transplant Proc 2017; 48:2669-2677. [PMID: 27788799 DOI: 10.1016/j.transproceed.2016.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/26/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Donor-related malignancy is a rare complication of organ transplantation. METHODS In this case series, we discuss three cases of donor-related cancers in kidney transplant recipients who were registered in our center between 1979 and 2015. They account for an incidence of 0.29% of donor-related malignancies of a total of 1015 transplanted kidney grafts (deceased and living donors). The three cases that we describe presented in different ways and with different severity, although the response to the initiated treatment was comparable. RESULTS All three patients not only survived their cancer episode but also had a complete oncological remission and underwent successful second kidney transplantation, accounting for a 100% survival rate in our small cohort. CONCLUSIONS Despite the very low incidence of this complication, transplant clinicians must be aware of the occurrence of donor-related malignancies when selecting a donor and should be able to diagnose and treat a case of donor-related cancer.
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Affiliation(s)
- L A Georgieva
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - E M Gielis
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; University of Antwerpen, Wilrijk, Belgium
| | - R Hellemans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - A H Van Craenenbroeck
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; University of Antwerpen, Wilrijk, Belgium
| | - M M Couttenye
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; University of Antwerpen, Wilrijk, Belgium
| | - D Abramowicz
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; University of Antwerpen, Wilrijk, Belgium
| | - G Van Beeumen
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - V Siozopoulou
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium
| | | | - B Bracke
- Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - V Hartman
- Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - K De Greef
- University of Antwerpen, Wilrijk, Belgium; Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - G Roeyen
- Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - T Chapelle
- Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - D Ysebaert
- University of Antwerpen, Wilrijk, Belgium; Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - J L Bosmans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; University of Antwerpen, Wilrijk, Belgium.
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144
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Wassano NS, Sergi F, Ferro G, Genzini T, D'Alpino Peixoto R. Rapid Disease Progression of Liver Metastases following Resection in a Liver-Transplanted Patient with Probable Lynch Syndrome – A Case Report and Review of the Literature. Case Rep Oncol 2017; 10:244-251. [PMID: 28611638 PMCID: PMC5465697 DOI: 10.1159/000460241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 01/20/2023] Open
Abstract
Solid organ transplantation provides life-saving therapy for patients with end-stage organ disease, and its outcomes have been improving dramatically over the past few decades. However, substantial morbidity results from chronic immunosuppressive therapy administered to prevent graft rejection. It predisposes patients to several life-threatening complications, such as opportunistic microbial infections and the development of different types of cancers. Here, we presented the case of a young man with probable Lynch syndrome, who developed an aggressive colon carcinoma after long-term immunosuppressive therapy due to a prior liver transplantation. Based on this case report, we attempt to find an answer to the question about the risk of cancer development or recurrence in patients with familial syndromes receiving long-term immunosuppressive therapy and to find out how it can be minimized. Answering these questions is particularly important, given the facts that disease course is substantially more aggressive among transplanted patients and that prognosis is poor due to lack of immunocompetence, especially in the setting of Lynch syndrome.
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Affiliation(s)
- Noelle Suemi Wassano
- aHospital São José (Beneficência Portuguesa de São Paulo), São Paulo, Brazil
- *Noelle Suemi Wassano, Hospital São José (Beneficência Portuguesa de São Paulo), Rua Monsenhor Passalaqua, 212. AP 84, São Paulo 01323010 (Brazil), E-Mail
| | - Francisco Sergi
- aHospital São José (Beneficência Portuguesa de São Paulo), São Paulo, Brazil
| | - Gustavo Ferro
- aHospital São José (Beneficência Portuguesa de São Paulo), São Paulo, Brazil
| | - Tércio Genzini
- aHospital São José (Beneficência Portuguesa de São Paulo), São Paulo, Brazil
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145
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Cancers solides après transplantation d’organe : épidémiologie, pronostic et spécificités de prise en charge. Bull Cancer 2017; 104:245-257. [DOI: 10.1016/j.bulcan.2016.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/22/2016] [Accepted: 12/30/2016] [Indexed: 12/20/2022]
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146
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Banach M, Robert J. Tumor immunology viewed from alternative animal models-the Xenopus story. CURRENT PATHOBIOLOGY REPORTS 2017; 5:49-56. [PMID: 28944105 DOI: 10.1007/s40139-017-0125-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A PURPOSE OF REVIEW Nonmammalian comparative animal models are important not only to gain fundamental evolutionary understanding of the complex interactions of tumors with the immune system, but also to better predict the applicability of novel immunotherapeutic approaches to humans. After reviewing recent advances in developing alternative models, we focus on the amphibian Xenopus laevis and its usefulness in deciphering the perplexing roles of MHC class I-like molecules and innate (i)T cells in tumor immunity. B RECENT FINDINGS Experiments using MHC-defined inbred and cloned animals, tumor cell lines, effective reagents, sequenced genomes, and adapted gene editing techniques in Xenopus, have revealed that the critical involvement of class I-like molecules and iT cells in tumor immunity has been conserved during evolution. C SUMMARY Comparative studies with the X. laevis tumor immunity model can contribute to the development of better and more efficient cancer immunotherapies.
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Affiliation(s)
- Maureen Banach
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, USA
| | - Jacques Robert
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, USA
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147
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Toor SM, Syed Khaja AS, El Salhat H, Bekdache O, Kanbar J, Jaloudi M, Elkord E. Increased Levels of Circulating and Tumor-Infiltrating Granulocytic Myeloid Cells in Colorectal Cancer Patients. Front Immunol 2016; 7:560. [PMID: 28008330 PMCID: PMC5143474 DOI: 10.3389/fimmu.2016.00560] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022] Open
Abstract
Increased levels of myeloid cells, especially myeloid-derived suppressor cells (MDSCs), have been reported to correlate with bad prognosis and reduced survival in cancer patients. However, limited data are available on their conclusive phenotypes and their correlation with clinical settings. The aim of this study was to investigate levels and phenotype of myeloid cells in peripheral blood and tumor microenvironment (TME) of colorectal cancer (CRC) patients, compared to blood from healthy donors (HDs) and paired, adjacent non-tumor colon tissue. Flow cytometric analysis was performed to examine the expression of different myeloid markers in fresh peripheral blood samples from CRC patients and HDs, and tissue-infiltrating immune cells from CRC patients. We found significantly higher levels of cells expressing myeloid markers and lacking the expression of major histocompatibility complex class II molecule HLA-DR in blood and tumor of CRC patients. Further analysis revealed that these cells were granulocytic and expressed Arginase 1 indicative of their suppressive phenotype. These expanded cells could be neutrophils or granulocytic MDSCs, and we refer to them as granulocytic myeloid cells (GMCs) due to the phenotypical and functional overlap between these cell subsets. Interestingly, the expansion of peripheral GMCs correlated with higher stage and histological grade of cancer, thereby suggesting their role in cancer progression. Furthermore, an increase in CD33+CD11b+HLA-DR-CD14-CD15- immature myeloid cells was also observed in CRC tumor tissue. Our work shows that GMCs are expanded in circulation and TME of CRC patients, which provides further insights for developing immunotherapeutic approaches targeting these cell subsets to enhance antitumor immune and clinical responses.
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Affiliation(s)
- Salman M. Toor
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Azharuddin Sajid Syed Khaja
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
- Cancer Research Center, Qatar Biomedical Research Institute, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Haytham El Salhat
- Oncology Department, Al Noor Hospital, Abu Dhabi, United Arab Emirates
| | | | | | | | - Eyad Elkord
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
- Cancer Research Center, Qatar Biomedical Research Institute, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
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148
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Muller N, Kessler R, Caillard S, Epailly E, Hubelé F, Heimburger C, Namer IJ, Herbrecht R, Blondet C, Imperiale A. 18F-FDG PET/CT for the Diagnosis of Malignant and Infectious Complications After Solid Organ Transplantation. Nucl Med Mol Imaging 2016; 51:58-68. [PMID: 28250859 DOI: 10.1007/s13139-016-0461-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 11/08/2016] [Accepted: 11/08/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Infection and malignancy represent two common complications after solid organ transplantation, which are often characterized by poorly specific clinical symptomatology. Herein, we have evaluated the role of 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) in this clinical setting. METHODS Fifty-eight consecutive patients who underwent FDG PET/CT after kidney, lung or heart transplantation were included in this retrospective analysis. Twelve patients underwent FDG PET/CT to strengthen or confirm a diagnostic suspicion of malignancies. The remaining 46 patients presented with unexplained inflammatory syndrome, fever of unknown origin (FUO), CMV or EBV seroconversion during post-transplant follow-up without conclusive conventional imaging. FDG PET/CT results were compared to histology or to the finding obtained during a clinical/imaging follow-up period of at least 6 months after PET/CT study. RESULTS Positive FDG PET/CT results were obtained in 18 (31 %) patients. In the remaining 40 (69 %) cases, FDG PET/CT was negative, showing exclusively a physiological radiotracer distribution. On the basis of a patient-based analysis, FDG PET/CT's sensitivity, specificity, PPV and NPV were respectively 78 %, 90 %, 78 % and 90 %, with a global accuracy of 86 %. FDG PET/CT was true positive in 14 patients with bacterial pneumonias (n = 4), pulmonary fungal infection (n = 1), histoplasmosis (n = 1), cutaneous abscess (n = 1), inflammatory disorder (sacroiliitis) (n = 1), lymphoma (n = 3) and NSCLC (n = 3). On the other hand, FDG PET/CT failed to detect lung bronchoalveolar adenocarcinoma, septicemia, endocarditis and graft-versus-host disease (GVHD), respectively, in four patients. FDG PET/CT contributed to adjusting the patient therapeutic strategy in 40 % of cases. CONCLUSIONS FDG PET/CT emerges as a valuable technique to manage complications in the post-transplantation period. FDG PET/CT should be considered in patients with severe unexplained inflammatory syndrome or FUO and inconclusive conventional imaging or to discriminate active from silent lesions previously detected by conventional imaging particularly when malignancy is suspected.
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Affiliation(s)
- Nastassja Muller
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
- Department of Nuclear Medicine, Haguenau Hospital, 64, avenue Prof. Rene Leriche, BP 40252, Haguenau, 67504 France
| | - Romain Kessler
- Pneumology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1 Place de l'hôpital, Strasbourg, 67000 France
- EA 7293 Vascular and Tissular Stress in Transplantation and FMTS, Faculty of Medicine, Strasbourg, France
| | - Sophie Caillard
- Nephrology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
| | - Eric Epailly
- Cardiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1 Place de l'hôpital, Strasbourg, 67000 France
| | - Fabrice Hubelé
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, Strasbourg, France
| | - Céline Heimburger
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
| | - Izzie-Jacques Namer
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, Strasbourg, France
| | - Raoul Herbrecht
- Oncology and Hematology, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
| | - Cyrille Blondet
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, Strasbourg, France
| | - Alessio Imperiale
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, Strasbourg, France
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149
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Kobayashi K, Shimokawa Miyama T, Itamoto K, Noguchi S, Baba K, Mizuno T, Okuda M. Development of hepatocellular carcinoma after long-term immunosuppressive therapy including danazol in a dog. J Vet Med Sci 2016; 78:1611-1614. [PMID: 27320967 PMCID: PMC5095632 DOI: 10.1292/jvms.16-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 2-year-old female beagle was referred to our hospital for evaluation of anemia. Laboratory tests, including bone marrow cytology, revealed non-regenerative immune-mediated anemia (NRIMA). Although initial immunosuppressive multi-drug therapy was not effective, additional administration of danazol was successful in treating the anemia. However, hepatocellular carcinoma (HCC) developed about 20 months after the administration of danazol. In humans, several cases of development of HCC after the administration of danazol have been reported. The present report describes a case of HCC development in a dog after chronic administration of danazol in addition to other immunosuppressive drugs.
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Affiliation(s)
- Kosuke Kobayashi
- Laboratory of Veterinary Internal Medicine, Joint Faculty of Veterinary Medicine, Yamaguchi University, 1677-1, Yoshida, Yamaguchi 753-8511, Japan
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150
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Ong M, Ibrahim AM, Bourassa-Blanchette S, Canil C, Fairhead T, Knoll G. Antitumor activity of nivolumab on hemodialysis after renal allograft rejection. J Immunother Cancer 2016; 4:64. [PMID: 27777773 PMCID: PMC5067882 DOI: 10.1186/s40425-016-0171-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/29/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Nivolumab (Opdivo™) is a novel IgG4 subclass programmed death-1 (PD-1) inhibiting antibody that has demonstrated breakthrough-designation anti-tumor activity. To date, clinical trials of nivolumab and other checkpoint inhibitors have generally excluded patients with solid organ transplantation and patients with concurrent immunosuppression. However, organ transplant recipients are at high-risk of development of malignancy as a result of suppressed immune surveillance of cancer. CASE PRESENTATION We illustrate the outcomes of a 63 year-old type I diabetic female patient who developed pulmonary metastatic, BRAF wild-type cutaneous melanoma 10 years after renal transplantation. After downward titration of the patient's immunosuppressive medications and extensive multidisciplinary review, she was treated with nivolumab in the first-line setting. Within 1 week of administration, the patient experienced acute renal allograft rejection, renal failure and concurrent diabetic ketoacidosis due to steroid therapy. Allograft function did not return, but patient made a full clinical recovery after being placed on hemodialysis. Subsequently, the patient had clinical disease progression off therapy and required re-challenge with nivolumab on hemodialysis, resulting in ongoing clinical and radiographic response. CONCLUSIONS This case illustrates multiple practical challenges and dangers of administering anti-PD1 immune checkpoint inhibitors to patients with solid-organ transplantation including need for titration of immunosuppressive medications, risks of allograft rejection, and treatment during hemodialysis.
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Affiliation(s)
- Michael Ong
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Andrea Marie Ibrahim
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | | | - Christina Canil
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Todd Fairhead
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Greg Knoll
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
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