Amy Kahn, MS, Research Scientist, New York State Cancer Registry (NAACCR Committee Member)
Central Cancer Registries from throughout the U.S. have been collaborating with researchers at the National Cancer Institute’s Intramural Research Program and with the Scientific Registry of Transplant Recipients Study to identify and quantify associations between receipt of solid organ transplants (including the use of immunosuppressive therapies) and subsequent cancer diagnoses. The first report coming out of this ‘Transplant Cancer Match Study’ project, “Spectrum of cancer risk among US solid organ transplant recipients” was published in JAMA in 2011. The most recent publication arising from this ongoing collaboration addresses melanoma incidence and was published in the Sept. 3rd edition of the Journal of Investigative Dermatology. Based on this paper, the overall standardized incidence ratio for invasive melanomas among transplant recipients was elevated by a factor of two relative to melanomas reported for the underlying statewide populations, with differences associated with localized versus regional/distant disease. Dr. Eric Engels, the NCI’s principle investigator of the project, has a long history of collaboration with central cancer registries.
Abstract
Solid organ transplant recipients, who are medically immunosuppressed to prevent graft rejection, have increased melanoma risk, but risk factors and outcomes are incompletely documented. We evaluated melanoma incidence among 139,991 non-Hispanic white transplants using linked US transplant-cancer registry data (1987–2010).We used standardized incidence ratios (SIRs) to compare incidence with the general population and incidence rate ratios (IRRs) from multivariable Poisson models to assess risk factors. Separately, we compared post-melanoma survival among transplant recipients (n=182) and non-recipients (n=131,358) using multivariable Cox models. Among transplant recipients, risk of invasive melanoma (n=519) was elevated (SIR=2.20, 95% CI 2.01–2.39), especially for regional stage tumors (SIR=4.11, 95% CI 3.27–5.09). Risk of localized tumors was stable over time after transplantation but higher with azathioprine maintenance therapy (IRR=1.35, 95% CI 1.03–1.77). Risk of regional/distant stage tumors peaked within 4 years following transplantation and increased with polyclonal antibody induction therapy (IRR=1.65, 95% CI 1.02–2.67). Melanoma-specific mortality was higher among transplant recipients than non-recipients (hazard ratio 2.98, 95% CI 2.26–3.93). Melanoma exhibits increased incidence and aggressive behavior under transplant-related immunosuppression. Some localized melanomas may result from azathioprine, which acts synergistically with UV radiation, whereas T-cell–depleting induction therapies may promote late-stage tumors. Our findings support sun safety practices and skin screening for transplant recipients.
The opinions expressed in this article are those of the authors and may not represent the official positions of NAACCR.
