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Mansilla-Polo M, López-Davia J, De Unamuno-Bustos B, Martín-Torregrosa D, Abril-Pérez C, Ezzatvar Y, Botella-Estrada R. Skin cancer risk after hematopoietic stem cell transplantation: a systematic review and meta-analysis. Int J Dermatol 2024. [PMID: 38987869 DOI: 10.1111/ijd.17371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/12/2024]
Abstract
Hematopoietic stem cell transplantation (HSCT) has improved outcomes for severe hematologic, malignant, and immune disorders, yet poses an increased risk of subsequent malignancies. This study aimed to examine the risk of skin cancer following HSCT and identify potential risk factors. The search was conducted in MEDLINE, EMBASE, and CINAHL databases until December 2023. Cohort studies reporting standardized incidence ratios (SIRs) for post-HSCT skin cancer or investigating risk factors were included. SIRs, or hazard ratios (HRs) with 95% confidence interval (CI), were calculated using random-effects inverse-variance models. Outcome endpoints were SIRs of skin cancer post-HSCT and risk factors, including gender, chronic graft-versus-host disease (cGVHD), voriconazole exposure, and total body irradiation (TBI). Twenty-six studies involving 164,944 HSCT recipients (allogeneic HSCT, n = 68,637; autologous HSCT, n = 95,435; mean age: 38.5 ± 13.8 years; 71,354 females [43.3%]) were analyzed. Overall, SIR for skin cancer post-HSCT was 7.21 (95% CI 3.98-13.08), with SIRs of 2.25 (95% CI: 1.37-3.68) for autologous HSCT, and 10.18 (95% CI 5.07-20.43) for allogeneic HSCT. Risk factors for skin cancer risk included cGVHD (HR = 2.86 [95% CI: 2.01-4.07]), specifically for basal cell and squamous cell carcinoma (SCC) (HR = 1.80 [95% CI: 1.31-2.46] and HR = 3.68 [95% CI: 2.39-5.68], respectively), male gender (HR = 1.56 [95% CI: 1.15-2.13]), especially for SCC (HR = 1.70 [95% CI: 1.03-2.80]), and voriconazole exposure (HR = 2.01 [95% CI: 1.12-3.61]). TBI showed no statistically significant association with subsequent skin cancer (HR = 1.12 [95% CI: 0.73-1.71]). These findings highlight the importance of rigorous skin cancer surveillance and preventive strategies in HSCT recipients, particularly in male individuals undergoing allogeneic transplants and those with identifiable risk factors, to enable early detection and intervention.
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Affiliation(s)
- Miguel Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
- Department of Dermatology, Universitat de València, Valencia, Spain
| | - Javier López-Davia
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Blanca De Unamuno-Bustos
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Daniel Martín-Torregrosa
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Carlos Abril-Pérez
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain
| | - Rafael Botella-Estrada
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
- Department of Dermatology, Universitat de València, Valencia, Spain
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2
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Jiang R, Fritz M, Que SKT. Cutaneous Squamous Cell Carcinoma: An Updated Review. Cancers (Basel) 2024; 16:1800. [PMID: 38791879 PMCID: PMC11119634 DOI: 10.3390/cancers16101800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Representing the second most common skin cancer, the incidence and disease burden of cutaneous squamous cell carcinoma (cSCC) continues to increase. Surgical excision of the primary site effectively cures the majority of cSCC cases. However, an aggressive subset of cSCC persists with clinicopathological features that are indicative of higher recurrence, metastasis, and mortality risks. Acceleration of these features is driven by a combination of genetic and environmental factors. The past several years have seen remarkable progress in shaping the treatment landscape for advanced cSCC. Risk stratification and clinical management is a top priority. This review provides an overview of the current perspectives on cSCC with a focus on staging, treatment, and maintenance strategies, along with future research directions.
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Affiliation(s)
- Rina Jiang
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Mike Fritz
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Syril Keena T. Que
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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3
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Kuklinski LF, Klomhaus AM, Shen A, Achamallah N, Soriano TT, Saggar R, Weigt SS. Posaconazole and risk of cutaneous squamous cell carcinoma after lung transplantation: a single institution, retrospective cohort study. Arch Dermatol Res 2023; 315:2643-2646. [PMID: 37558828 DOI: 10.1007/s00403-023-02699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Lawrence F Kuklinski
- Division of Dermatology, Department of Medicine, UCLA Medical Center, CA, Los Angeles, USA.
| | - Alexandra M Klomhaus
- Department of Medicine Statistics Core, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Amy Shen
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Natalie Achamallah
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Teresa T Soriano
- Division of Dermatology, Department of Medicine, UCLA Medical Center, CA, Los Angeles, USA
| | - Rajan Saggar
- Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA
| | - Stephen S Weigt
- Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA
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4
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Bossi P, Ascierto PA, Basset-Seguin N, Dreno B, Dummer R, Hauschild A, Mohr P, Kaufmann R, Pellacani G, Puig S, Moreno-Ramírez D, Robert C, Stratigos A, Gutzmer R, Queirolo P, Quaglino P, Peris K. Long-term strategies for management of advanced basal cell carcinoma with hedgehog inhibitors. Crit Rev Oncol Hematol 2023; 189:104066. [PMID: 37442495 DOI: 10.1016/j.critrevonc.2023.104066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/12/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023] Open
Abstract
Basal cell carcinoma (BCC), the most common type of skin cancer, is characterized by aberrant activation of the hedgehog molecular pathway. Systemic therapy is indicated when local approaches, such as surgery and radiation, are inappropriate. In this article, a group of clinical experts recommends the long-term management strategy for advanced BCC patients treated with systemic therapy. The hedgehog inhibitors sonidegib and vismodegib are first-line treatments for advanced BCC with a long-lasting response, but long-term treatment with hedgehog inhibitors is often challenged by tolerability issues. However, several strategies for adverse effect management are available, such as dose interruptions, on-label alternate-day dosing and supportive medications. In conclusion, although BCC shows a high tumor mutational burden that favors a response to immunotherapy, experts recommend keeping patients on hedgehog inhibitors limiting immunotherapy to those who developed resistance during hedgehog inhibitor therapy or in case of persisting toxicity despite long-term management of adverse events.
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Affiliation(s)
- Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Paolo A Ascierto
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | - Brigitte Dreno
- Department of Dermato Oncology, University Hospital Nantes, Nantes, France
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Campus Kiel, Kiel, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Susana Puig
- Hospital Clinic de Barcelona, Universitat de Barcelona, Spain & Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - David Moreno-Ramírez
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Caroline Robert
- Gustave Roussy and INSERM U981, Villejuif, Paris Sud, France
| | - Alex Stratigos
- Dept of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | | | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy and Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
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5
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Winge MCG, Kellman LN, Guo K, Tang JY, Swetter SM, Aasi SZ, Sarin KY, Chang ALS, Khavari PA. Advances in cutaneous squamous cell carcinoma. Nat Rev Cancer 2023:10.1038/s41568-023-00583-5. [PMID: 37286893 DOI: 10.1038/s41568-023-00583-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/09/2023]
Abstract
Human malignancies arise predominantly in tissues of epithelial origin, where the stepwise transformation from healthy epithelium to premalignant dysplasia to invasive neoplasia involves sequential dysregulation of biological networks that govern essential functions of epithelial homeostasis. Cutaneous squamous cell carcinoma (cSCC) is a prototype epithelial malignancy, often with a high tumour mutational burden. A plethora of risk genes, dominated by UV-induced sun damage, drive disease progression in conjunction with stromal interactions and local immunomodulation, enabling continuous tumour growth. Recent studies have identified subpopulations of SCC cells that specifically interact with the tumour microenvironment. These advances, along with increased knowledge of the impact of germline genetics and somatic mutations on cSCC development, have led to a greater appreciation of the complexity of skin cancer pathogenesis and have enabled progress in neoadjuvant immunotherapy, which has improved pathological complete response rates. Although measures for the prevention and therapeutic management of cSCC are associated with clinical benefit, the prognosis remains poor for advanced disease. Elucidating how the genetic mechanisms that drive cSCC interact with the tumour microenvironment is a current focus in efforts to understand, prevent and treat cSCC.
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Affiliation(s)
- Mårten C G Winge
- Program in Epithelial Biology, Stanford University, Stanford, CA, USA
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | - Laura N Kellman
- Program in Epithelial Biology, Stanford University, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
- Stanford Program in Cancer Biology, Stanford University, Stanford, CA, USA
| | - Konnie Guo
- Program in Epithelial Biology, Stanford University, Stanford, CA, USA
| | - Jean Y Tang
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Redwood City, CA, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Sumaira Z Aasi
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | - Anne Lynn S Chang
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | - Paul A Khavari
- Program in Epithelial Biology, Stanford University, Stanford, CA, USA.
- Department of Dermatology, Stanford University, Redwood City, CA, USA.
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
- Stanford Program in Cancer Biology, Stanford University, Stanford, CA, USA.
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA.
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6
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Babakoohi S, Gu SL, Ehsan H, Markova A. Dermatologic complications in transplantation and cellular therapy for acute leukemia. Best Pract Res Clin Haematol 2023; 36:101464. [PMID: 37353285 PMCID: PMC10291442 DOI: 10.1016/j.beha.2023.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
Adoptive cellular immunotherapy, mainly hematopoietic stem cell transplant and CAR-T cell therapy have revolutionized treatment of patients with acute leukemia. Indications and inclusion criteria for these treatments have expanded in recent years. While these therapies are associated with significant improvements in disease response and overall survival, patients may experience adverse events from associated chemotherapy conditioning, engraftment, cytokine storm, supportive medications, and post-transplant maintenance targeted therapies. Supportive oncodermatology is a growing specialty to manage cutaneous toxicities resulting from the anti-cancer therapies. In this review, we summarize diagnosis and management of the common cutaneous adverse events including drug eruptions, graft-versus-host disease, neoplastic and paraneoplastic complications in patients undergoing cellular therapies.
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Affiliation(s)
- Shahab Babakoohi
- Levine Cancer Institute, Atrium Health Wake Forest Baptist, Charlotte, NC, USA.
| | - Stephanie L Gu
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Hamid Ehsan
- Levine Cancer Institute, Atrium Health Wake Forest Baptist, Charlotte, NC, USA
| | - Alina Markova
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
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7
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Systemic Antifungal Therapy for Invasive Pulmonary Infections. J Fungi (Basel) 2023; 9:jof9020144. [PMID: 36836260 PMCID: PMC9966409 DOI: 10.3390/jof9020144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Antifungal therapy for pulmonary fungal diseases is in a state of flux. Amphotericin B, the time-honored standard of care for many years, has been replaced by agents demonstrating superior efficacy and safety, including extended-spectrum triazoles and liposomal amphotericin B. Voriconazole, which became the treatment of choice for most pulmonary mold diseases, has been compared with posaconazole and itraconazole, both of which have shown clinical efficacy similar to that of voriconazole, with fewer adverse events. With the worldwide expansion of azole-resistant Aspergillus fumigatus and infections with intrinsically resistant non-Aspergillus molds, the need for newer antifungals with novel mechanisms of action becomes ever more pressing.
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8
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Haddad S, Younis I, Bakkour W, Waters LJ, Perrett C, Ratynska M, Bunker CB. Accelerated photocarcinogenesis and multifocal squamous cell carcinomas associated with voriconazole and human papillomavirus in HIV - case report. Int J STD AIDS 2023; 34:67-70. [PMID: 36285627 DOI: 10.1177/09564624221121199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Voriconazole is an antifungal with known side effects of phototoxicity and photocarcinogenesis. We present a case of HPV-related multifocal squamous cell carcinoma in a 68-year-old man with HIV, due to accelerated photocarcinogenesis associated with long-term use of voriconazole. Histology confirmed SCC with HPV-related features and he was found to have metastases. Multifocal SCC is unusual in association with voriconazole and HIV infection and only one other case has been reported. It is important for clinicians to be aware of the photocarcinogenic effects of voriconazole, especially in patients with HIV.
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Affiliation(s)
- Salma Haddad
- 8964University College London NHS Trust, London, UK
| | - Ibby Younis
- 8964University College London NHS Trust, London, UK
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9
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Kawano N, Nakamura S, Mochida K, Yoshida S, Kuriyama T, Nakaike T, Shimokawa T, Tochigi T, Yamashita K, Mashiba K, Kikuchi I, Takarabe A, Moriguchi S, Mori Y, Takenaka K, Shimoda K, Ochiai H, Amano M. Secondary Skin Cancer in a Case with Long-term Voriconazole after Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia. Intern Med 2022; 61:2771-2774. [PMID: 35022348 PMCID: PMC9556231 DOI: 10.2169/internalmedicine.8618-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Secondary malignancies that develop after allogeneic-hematopoietic stem cell transplantation (allo-HSCT) have become serious issues. A 47-year-old man who developed acute myeloid leukemia in 2009 and subsequently underwent allo-HSCT twice: in 2009 and 2011. In 2015, voriconazole for lung aspergillus was started. In 2018, chronic graft-versus-host disease (GVHD) and multiple actinic keratoses manifested at his head. In 2020, some lesions were diagnosed as squamous cell carcinoma, so voriconazole was withdrawn, and subsequent surgery and radiation led to remission. Long-term administration of voriconazole in addition to allo-HSCT and chronic GVHD may be closely related to secondary skin cancer.
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Affiliation(s)
- Noriaki Kawano
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Shunou Nakamura
- Department of Dermatology, Faculty of Medicine, University of Miyazaki, Japan
| | - Kousuke Mochida
- Department of Dermatology, Faculty of Medicine, University of Miyazaki, Japan
| | - Shuro Yoshida
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Takuro Kuriyama
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Takashi Nakaike
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Tomonori Shimokawa
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Taro Tochigi
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Kiyoshi Yamashita
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Koichi Mashiba
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Ikuo Kikuchi
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Aina Takarabe
- Department of Dermatology, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Sayaka Moriguchi
- Department of Pathology, Miyazaki Prefectural Miyazaki Hospital, Japan
| | - Yasuo Mori
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Katsuto Takenaka
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Japan
| | - Kazuya Shimoda
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Hidenobu Ochiai
- Trauma and Critical Care Center, Faculty of Medicine, University of Miyazaki, Japan
| | - Masahiro Amano
- Department of Dermatology, Faculty of Medicine, University of Miyazaki, Japan
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10
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Pérez-López M, Bort-Marti M, Fernández-Santodomingo A, Matthews C, España-Gregori E. Rapid-onset voriconazole-induced cicatricial ectropion. J Fr Ophtalmol 2022; 45:e221-e223. [DOI: 10.1016/j.jfo.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/19/2021] [Accepted: 06/21/2021] [Indexed: 10/18/2022]
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12
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Cohort and Nested Case-Control Study of Cutaneous Squamous Cell Carcinoma in Solid Organ Transplant Recipients, by Medication. J Am Acad Dermatol 2021; 86:598-606. [PMID: 34384835 DOI: 10.1016/j.jaad.2021.07.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Knowledge is needed about squamous cell carcinoma (cSCC) risk in solid organ transplant recipients (SOTRs) using contemporary immunosuppressive regimens. OBJECTIVE Evaluate risk of cSCC in relation to medications used by SOTRs. METHODS The cohort and nest case-control study included 3,308 SOTRs and 65,883 persons without transplantation during 2009-2019. Incident cSCC was identified from pathology data and medications from pharmacy data. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards analysis, with voriconazole examined as a time-dependent variable. RESULTS The annual incidence of cSCC was 1.69% in SOTRs and 0.30% in persons without transplantation. The adjusted HR of cSCC associated with lung transplant was 14.83 (CI 9.85-22.33) for lung and 6.53 to 10.69 for other organs. Risk in Latinx persons was higher than in other non-white groups. Among lung recipients, the HR was 1.14 for each month of voriconazole use (95% CI: 1.04-1.26). Azathioprine use for ≥7 months, relating to mycophenolate mofetil intolerance, was associated with 4.22-fold increased risk of cSCC (95% CI 1.90-9.40). Belatacept and other immunsuppressive medications were not associated with risk. LIMITATIONS The number of events was somewhat small. CONCLUSIONS Knowledge of risks and benefits in diverse patients can translate to care improvements.
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Abstract
Over the past 15 years, there has been an increase in the development and utilization of newer antifungal agents. The ideal antifungal, however, in regard to spectrum of activity, pharmacokinetic/pharmacodynamic properties, development of resistance, safety, and drug interaction profile remains elusive. This article reviews pharmacologic aspects of Food and Drug Administration-approved polyenes, flucytosine, azoles, and echinocandins as well as promising pipeline antifungal agents. Unique properties of these newer agents are highlighted. The clinical role of established and investigational antifungal agents as treatment and/or prevention of invasive fungal infections is discussed.
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Affiliation(s)
- Melissa D Johnson
- Duke University Medical Center, Box 102359 DUMC, Durham NC 27710, USA.
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14
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Photosensitizing Medications and Skin Cancer: A Comprehensive Review. Cancers (Basel) 2021; 13:cancers13102344. [PMID: 34066301 PMCID: PMC8152064 DOI: 10.3390/cancers13102344] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 12/24/2022] Open
Abstract
(1) The incidence of skin cancer is increasing in the United States (US) despite scientific advances in our understanding of skin cancer risk factors and treatments. In vitro and in vivo studies have provided evidence that suggests that certain photosensitizing medications (PSMs) increase skin cancer risk. This review summarizes current epidemiological evidence on the association between common PSMs and skin cancer. (2) A comprehensive literature search was conducted to identify meta-analyses, observational studies and clinical trials that report on skin cancer events in PSM users. The associated risks of keratinocyte carcinoma (squamous cell carcinoma and basal cell carcinoma) and melanoma are summarized, for each PSM. (3) There are extensive reports on antihypertensives and statins relative to other PSMs, with positive and null findings, respectively. Fewer studies have explored amiodarone, metformin, antimicrobials and vemurafenib. No studies report on the individual skin cancer risks in glyburide, naproxen, piroxicam, chlorpromazine, thioridazine and nalidixic acid users. (4) The research gaps in understanding the relationship between PSMs and skin cancer outlined in this review should be prioritized because the US population is aging. Thus the number of patients prescribed PSMs is likely to continue to rise.
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15
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D'Arcy ME, Pfeiffer RM, Rivera DR, Hess GP, Cahoon EK, Arron ST, Brownell I, Cowen EW, Israni AK, Triplette MA, Yanik EL, Engels EA. Voriconazole and the Risk of Keratinocyte Carcinomas Among Lung Transplant Recipients in the United States. JAMA Dermatol 2021; 156:772-779. [PMID: 32401271 PMCID: PMC7221851 DOI: 10.1001/jamadermatol.2020.1141] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Question What is the association between voriconazole, an antifungal used to treat aspergillosis infections, and the risk of keratinocyte carcinomas among recipients of lung transplants? Findings In a population-based cohort study of 9599 non-Hispanic white recipients of 9793 lung transplants in the United States (2007-2016) with linkage to pharmacy claims, increasing cumulative voriconazole exposure was associated with an increased risk of cutaneous squamous cell carcinoma. Meaning These findings suggest that physicians caring for lung transplant recipients at high risk for aggressive keratinocyte carcinomas should limit voriconazole exposure when possible and encourage skin protection behaviors and more frequent cancer screenings. Importance The antifungal medication voriconazole is used to prevent and treat aspergillosis, a major cause of mortality among recipients of lung transplants (hereinafter referred to as lung recipients). Small studies suggest that voriconazole increases risk of cutaneous squamous cell carcinoma (SCC). Objective To examine associations of voriconazole and other antifungal medications with risk of keratinocyte carcinomas (SCC and cutaneous basal cell carcinoma [BCC]) in lung recipients. Design, Setting, and Participants This population-based cohort study included non-Hispanic white patients (n = 9599) who underwent lung transplant in the United States from January 1, 2007, to December 31, 2016, identified through the national Scientific Registry of Transplant Recipients with data linkable to pharmacy claims. Data were analyzed from March 1, 2018, to February 13, 2019. Exposures Antifungal medication use, including voriconazole, itraconazole, posaconazole, and other antifungals, was ascertained from pharmacy claims and treated as a time-varying exposure (assessed every 30 days). Cumulative antifungal exposure was calculated as the total number of exposed months. Main Outcomes and Measures Primary outcomes were the first SCC or BCC reported to the transplant registry by transplant centers. Follow-up began at transplant and ended at SCC or BCC diagnosis, transplant failure or retransplant, death, loss to follow-up, or December 31, 2016. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (AHRs) for each antifungal medication. Results Among the 9793 lung transplants in 9599 recipients included in the analysis, median age at transplant was 59 (interquartile range [IQR], 48-65) years, 5824 (59.5%) were male, and 5721 (58.4%) reported ever smoking. During a median follow-up of 3.0 (IQR, 1.4-5.0) years after transplant, 1031 SCCs (incidence, 322 per 10 000 person-years) and 347 BCCs (incidence, 101 per 10 000 person-years) were reported. Compared with lung recipients with no observed voriconazole use, those with 1 to 3 months of voriconazole use experienced increased AHR for SCC of 1.09 (95% CI, 0.90-1.31); 4 to 7 months, 1.42 (95% CI, 1.16-1.73); 8 to 15 months, 2.04 (95% CI, 1.67-2.50); and more than 15 months, 3.05 (95% CI, 2.37-3.91). Ever itraconazole exposure was associated with increased SCC risk (AHR, 1.20; 95% CI, 1.00-1.45). For BCC, risk was not associated with voriconazole use but was increased with itraconazole use (AHR, 1.74; 95% CI, 1.27-2.37) or posaconazole use (AHR, 1.55; 95% CI, 1.00-2.41). Conclusions and Relevance In this study, voriconazole use was associated with increased SCC risk among lung recipients, especially after prolonged exposure. Further research evaluating the risk-benefit ratio of shorter courses or alternative medications in transplant recipients at high risk for SCC should be considered.
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Affiliation(s)
- Monica E D'Arcy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Donna R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Gregory P Hess
- The Wharton School, University of Pennsylvania, Philadelphia
| | - Elizabeth K Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Sarah T Arron
- Department of Dermatology, University of California, San Francisco
| | - Isaac Brownell
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Edward W Cowen
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ajay K Israni
- Kidney Transplant Program, Hennepin Healthcare, University of Minnesota, Minneapolis.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Matthew A Triplette
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle
| | | | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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16
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Scorzoni L, Fuchs BB, Junqueira JC, Mylonakis E. Current and promising pharmacotherapeutic options for candidiasis. Expert Opin Pharmacother 2021; 22:867-887. [PMID: 33538201 DOI: 10.1080/14656566.2021.1873951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Candida spp. are commensal yeasts capable of causing infections such as superficial, oral, vaginal, or systemic infections. Despite medical advances, the antifungal pharmacopeia remains limited and the development of alternative strategies is needed.Areas covered: We discuss available treatments for Candida spp. infections, highlighting advantages and limitations related to pharmacokinetics, cytotoxicity, and antimicrobial resistance. Moreover, we present new perspectives to improve the activity of the available antifungals, discussing their immunomodulatory potential and advances on drug delivery carriers. New therapeutic approaches are presented including recent synthesized antifungal compounds (Enchochleated-Amphotericin B, tetrazoles, rezafungin, enfumafungin, manogepix and arylamidine); drug repurposing using a diversity of antibacterial, antiviral and non-antimicrobial drugs; combination therapies with different compounds or photodynamic therapy; and innovations based on nano-particulate delivery systems.Expert opinion: With the lack of novel drugs, the available assets must be leveraged to their best advantage through modifications that enhance delivery, efficacy, and solubility. However, these efforts are met with continuous challenges presented by microbes in their infinite plight to resist and survive therapeutic drugs. The pharmacotherapeutic options in development need to focus on new antimicrobial targets. The success of each antimicrobial agent brings strategic insights to the next phased approach in treatingCandida spp. infections.
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Affiliation(s)
- Liliana Scorzoni
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University/UNESP, SP Brazil
| | - Beth Burgwyn Fuchs
- Division of Infectious Diseases, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, RI USA
| | - Juliana Campos Junqueira
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University/UNESP, SP Brazil
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, RI USA
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17
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Vecchiato M, Piaserico S, Biolo G, Frigo AC, Loy M, Rea F, Russo I, Alaibac M. Skin cancers in Italian lung transplant recipients: Incidence and risk factors analysis. Dermatol Ther 2021; 34:e14749. [PMID: 33403691 DOI: 10.1111/dth.14749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022]
Abstract
Only a few studies reported the incidence and risk factors of skin cancers in lung transplant recipients. The aim of this study was to determine the cumulative incidence of skin cancers in a cohort of patients undergoing lung transplantation and to define predictors of their development. About 247 consecutive patients receiving lung transplantation at the Thoracic Surgery Unit of University Hospital of Padova between May 1995 and October 2016 were studied. Cumulative incidence of skin cancers was estimated considering death as a competing event. The effect of potential predictors was evaluated with univariate and multivariable Cox models for competing risks. About 37 (15.0%) patients developed skin tumors. The cumulative incidence of any skin cancer was 14.2% at 5 years, 21.4% at 10 years, and 24.3% at 15 years posttransplantation. Age at transplantation, male gender, phototype II, and voriconazole use were independent risk factors for development of squamous cell carcinoma. Only male gender and phototype II were independent risk factors for development of basal cell carcinoma. Since lung transplant recipients have a greater risk of developing skin cancers, the management of these patients needs a multidisciplinary approach, in which dermatologists and transplant physicians have a primary role.
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Affiliation(s)
- Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - Giulia Biolo
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology, and Public Health Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University Hospital, Padova, Italy
| | - Monica Loy
- Thoracic Surgical Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgical Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Irene Russo
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - Mauro Alaibac
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
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18
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Abstract
Neonates and immunosuppressed/immunocompromised pediatric patients are at high risk of invasive fungal diseases. Appropriate antifungal selection and optimized dosing are imperative to the successful prevention and treatment of these life-threatening infections. Conventional amphotericin B was the mainstay of antifungal therapy for many decades, but dose-limiting nephrotoxicity and infusion-related adverse events impeded its use. Despite the development of several new antifungal classes and agents in the past 20 years, and their now routine use in at-risk pediatric populations, data to guide the optimal dosing of antifungals in children are limited. This paper reviews the spectra of activity for approved antifungal agents and summarizes the current literature specific to pediatric patients regarding pharmacokinetic/pharmacodynamic data, dosing, and therapeutic drug monitoring.
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Affiliation(s)
- Kevin J Downes
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 2716 South Street, Suite 10360, Philadelphia, PA, 19146, USA.
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Brian T Fisher
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 2716 South Street, Suite 10360, Philadelphia, PA, 19146, USA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole R Zane
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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19
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Abstract
Lung transplantation is an established therapeutic option for selected patients with advanced lung diseases. As early outcomes after lung transplantation have improved, chronic medical illnesses have emerged as significant obstacles to long-term survival. Among them is post-transplant malignancy, currently representing the 2nd most common cause of death 5–10 years after transplantation. Chronic immunosuppressive therapy and resulting impairment of anti-tumor immune surveillance is thought to have a central role in cancer development after solid organ transplantation (SOT). Lung transplant recipients receive more immunosuppression than other SOT populations, likely contributing to even higher risk of cancer among this group. The most common cancers in lung transplant recipients are non-melanoma skin cancers, followed by lung cancer and post-transplant lymphoproliferative disorder (PTLD). The purpose of this review is to outline the common malignancies following lung transplant, their risk factors, prognosis and current means for both prevention and treatment.
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Affiliation(s)
- Osnat Shtraichman
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Pulmonary Institute, Rabin Medical Center, Affiliated with Sackler School of Medicine Tel Aviv University, Petach Tikva, Israel
| | - Vivek N Ahya
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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20
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Way M, Marquart L, Chambers DC, Hopkins P, Miura K, Jiyad Z, Plasmeijer EI, Ferguson LE, Davis M, Whiteman DC, Soyer HP, O'Rourke P, Green AC. Skin cancer multiplicity in lung transplant recipients: a prospective population-based study. Br J Dermatol 2020; 183:503-508. [PMID: 31853948 DOI: 10.1111/bjd.18812] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Lung transplant recipients are at high risk of skin cancer, but precise annual incidence rates of treated skin cancers per patient are unknown. OBJECTIVES To perform a prospective assessment of the total burden of histologically confirmed squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) and associated factors in lung transplant recipients. METHODS A population-based cohort of 125 Queensland lung transplant recipients aged 18 years and over, recruited between 2013 and 2015, were followed to the end of 2016. All underwent dermatological skin examinations at baseline and annually thereafter and patients self-reported all interim treated skin cancers, which were verified against pathology databases. Standard skin cancer risk factors were obtained via questionnaire, and details of medications were acquired from hospital records. RESULTS During a median follow-up time of 1·7 years, 29 (23%) and 30 (24%) lung transplant recipients with a median duration of immunosuppression of 3·3 years developed SCC and BCC, respectively. The general population age-standardized incidence rates of SCC and BCC were 201 and 171 per 1000 person-years, respectively (based on first primary SCC or BCC during follow-up); however, on accounting for multiple primary tumours, corresponding incidence rates were 447 and 281 per 1000 person-years. Risk of multiple SCCs increased around sixfold in those aged ≥ 60 years and in those with previous skin cancer, and increased around threefold in those treated with the antifungal medication voriconazole. Multiple BCC risk rose threefold from age 60 years and tenfold for patients with previous skin cancer. CONCLUSIONS Lung transplant recipients have very high incidence of multiple primary skin cancers. Close surveillance and assiduous prevention measures are essential. Linked Comment: Proby and Harwood. Br J Dermatol 2020; 183:416-417.
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Affiliation(s)
- M Way
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - L Marquart
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - D C Chambers
- Queensland Lung Transplant Service, Prince Charles Hospital; and School of Medicine, University of Queensland, Brisbane, Australia
| | - P Hopkins
- Queensland Lung Transplant Service, Prince Charles Hospital; and School of Medicine, University of Queensland, Brisbane, Australia
| | - K Miura
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Z Jiyad
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Institute of Cardiovascular and Cell Sciences (Dermatology Unit), St George's University of London, London, U.K
| | - E I Plasmeijer
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Dermatology, Erasmus Medical Centre, Erasmus University, Rotterdam, the Netherlands
| | - L E Ferguson
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - M Davis
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - D C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - H P Soyer
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia.,Dermatology Research Centre, University of Queensland, University of Queensland Diamantina Institute, Brisbane, Australia
| | - P O'Rourke
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - A C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,CRUK Manchester Institute and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, U.K
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21
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Elnahas S, Olson MT, Kang P, Panchanathan R, Masuda T, Walia R, Zeitouni NC, Smith MA, Bremner RM. Factors associated with skin cancer in lung transplant recipients: A single-center experience. Clin Transplant 2019; 33:e13718. [PMID: 31545540 DOI: 10.1111/ctr.13718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/30/2019] [Accepted: 09/18/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Skin cancer is common after solid organ transplantation, but few have investigated it after lung transplant (LTx). OBJECTIVE We assessed incidence and predictors of non-melanoma skin cancer (NMSC) post-LTx. METHODS We studied patients who underwent LTx at our center from 2012 to 2015. RESULTS Of 287 patients, mean age was 59.6 ± 11 years, 170 (59.2%) were men, and 231 (80.5%) were white. Seventy-six (26.5%) developed NMSC over a median follow-up of 32 months (IQR, 23-45). Of those with NMSC, 37% developed subsequent skin cancer of the same type. Independent predictors of decreased odds of NMSC and squamous cell carcinoma (SCC) were non-white race (P = .002; P = .003) and body mass index >30 kg/m2 compared with underweight patients (P = .001, P = .009). Patients with skin cancer pre-LTx had higher risk of post-LTx skin cancer (P = .02). Voriconazole use ≥100 days was associated with increased risk of SCC (P = .03), but not increased risk of basal cell carcinoma. Out of 76, 4 (5.3%) died from skin cancer. LIMITATIONS Retrospective, single-center study. CONCLUSION Squamous cell carcinoma risk post-LTx may increase with prolonged voriconazole use in white patients with pre-LTx history of skin cancer, whereas excess body weight may be protective from NMSC. Regular pre- and post-LTx skin cancer screenings and guidelines are warranted.
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Affiliation(s)
- Shaimaa Elnahas
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T Olson
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.,University of Arizona College of Medicine, Phoenix, Arizona
| | - Paul Kang
- University of Arizona College of Public Health, Phoenix, Arizona
| | | | - Takahiro Masuda
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nathalie C Zeitouni
- Department of Dermatology, University of Arizona College of Medicine, Phoenix, Arizona
| | - Michael A Smith
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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22
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Herr MM, Curtis RE, Tucker MA, Tecca HR, Engels EA, Cahoon EK, Battiwalla M, Buchbinder D, Flowers ME, Brazauskas R, Shaw BE, Morton LM. Risk factors for the development of cutaneous melanoma after allogeneic hematopoietic cell transplantation. J Am Acad Dermatol 2019; 83:762-772. [PMID: 31654664 DOI: 10.1016/j.jaad.2019.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/17/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Melanoma risk is increased after allogeneic hematopoietic cell transplantation (HCT), but specific risk factors are unknown. OBJECTIVE Investigate risk factors for melanoma after allogeneic hematopoietic cell transplantation. METHODS We conducted a nested case-control study of 140 melanoma cases and 557 controls (matched by age at HCT, sex, primary disease, survival time) through the Center for International Blood and Marrow Transplant Research. RESULTS Melanoma risk was significantly increased among HCT survivors who received total body irradiation-based myeloablative conditioning (multivariable adjusted odds ratio [OR] = 1.77; 95% confidence interval [CI] = 1.00-3.15) or reduced-intensity conditioning containing melphalan (OR = 2.60; 95% CI = 1.13-6.02) or fludarabine (OR = 2.72; 95% CI = 1.02-7.30) versus busulfan-based myeloablative regimens; were diagnosed with acute graft-versus-host disease (GVHD) with stage 2+ skin involvement (OR = 1.92; 95% CI = 1.19-3.10), chronic GvHD without skin involvement (OR = 1.91; 95% CI = 1.03-3.57), or keratinocytic carcinoma (OR = 2.37; 95% CI = 1.16-4.83); and resided in areas with higher ambient ultraviolet radiation (ORtertile3 = 1.64; 95% CI = 1.01-2.67). LIMITATIONS Data on individual-level ultraviolet radiation exposure and clinical data on melanoma characteristics were lacking. Additionally, misclassification of melanoma is possible as not all pathology reports were available for review. CONCLUSION These results emphasize the importance of adherence to current surveillance guidelines (routine skin examination, photoprotection recommendations), particularly for HCT survivors at highest risk.
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Affiliation(s)
- Megan M Herr
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Rochelle E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Margaret A Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Heather R Tecca
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Elizabeth K Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | | | - David Buchbinder
- Department of Hematology and Bone Marrow Transplant, Children's Hospital of Orange County, Orange, California
| | - Mary E Flowers
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
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23
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Mizuno S, Itoh M, Matsuo H, Kikuchi S, Asahina A. Case of ultraviolet B-mediated photosensitivity during the administration of voriconazole. J Dermatol 2019; 46:e327-e328. [PMID: 31021004 DOI: 10.1111/1346-8138.14874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sayaka Mizuno
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Munenari Itoh
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruka Matsuo
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sota Kikuchi
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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24
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Williams A, Gwinn C, Iyer J, Fleckman P, Shinohara MM. The management of numerous carcinomatous sequelae of human papilloma virus in an allogeneic stem cell transplant patient with chronic graft versus host disease. JAAD Case Rep 2019; 5:162-166. [PMID: 30733986 PMCID: PMC6355441 DOI: 10.1016/j.jdcr.2018.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Amanda Williams
- University of Washington School of Medicine, Seattle, Washington
| | - Courtney Gwinn
- Division of Dermatology, University of Washington, Seattle, Washington
| | - Jayasri Iyer
- Division of Dermatology, University of Washington, Seattle, Washington
| | - Philip Fleckman
- Division of Dermatology, University of Washington, Seattle, Washington
| | - Michi M Shinohara
- Division of Dermatology, University of Washington, Seattle, Washington.,Division of Dermatopathology, University of Washington, Seattle, Washington
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