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Statins May Cut Cancer Risk Post-Heart Transplant
“the authors note that cancer is the leading cause of death late after heart transplantation. Although newer immunosuppressive regimens have improved the situation, the incidence of malignancy is still estimated at about 20% after 10 years of chronic immunosuppression, and the relative risk may increase 100-fold for specific cancers in comparison with the general population.
Heart-transplant patients are at particular risk of developing malignancies--with their risk increased up to fourfold compared with renal-transplant recipients, probably because of the higher levels of immunosuppression used, Ruschitzka explained.
Heart Transplantation and Cancer
- Krikorian JG, Anderson JL, Beiber CP, Penn I, Stinson E: Malignant neoplasms following cardiac transplantation. JAMA 240:639–643, 1978.
- Penn I: Cancer after cardiac allograft transplantation. In Cardiac Transplantation (ed Losman J) Boston, Martinus Nijhoff.
- Penn I: Tumors after renal and cardiac transplantation. Hematology-Oncology Clin N Amer 7:431–445, 1993.
Aggressive cutaneous malignancies following cardiothoracic transplantation: the Australian experience.
- 1Department of Radiation Oncology, Westmead Hospital, Sydney, NSW, Australia.
The development of malignancies in recipients of a cardiothoracic transplant (CTT)--that is, heart, lung, or heart and lung recipients-is of concern. Cutaneous and lymphoproliferative malignancies comprise the two major groups of malignancies encountered. A small subgroup of patients will develop potentially life-threatening aggressive cutaneous malignancies (ACM); these are poorly defined and documented in the literature. The authors report the results for 619 CTT recipients from a single institution.
Between 1984 and 1995, 619 recipients received a CTT. With a minimum follow-up of 2 years, 66 patients (10.7%) were diagnosed with a major malignancy, and 27 of these 66 patients developed ACM. ACM were defined as having one or more of the following characteristics: local invasion and/or regional metastases at diagnosis, poor differentiation, and locoregional and/or systemic relapse following therapy. All malignant melanomas were considered ACM. Data on malignancy occurrence were documented in the clinical notes of the heart and lung transplant unit. A retrospective analysis was undertaken from these notes.
Tumor histology was predominantly poorly differentiated squamous cell carcinoma (55%) (SCC) and malignant melanoma (30%) (MM). No patient developed Kaposi sarcoma (KS). The median time from transplant to diagnosis of ACM was 52 months (range, 8-127 months). Thirteen of 27 patients have died; 10 of them died of metastatic disease. The mean time to death was 20 months (range, 8-54 months). Of 14 patients alive, 5 have disease. All but one of the 19 patients diagnosed with nonmelanoma ACM received radiotherapy, either as part of initial treatment or on relapse. Eight patients have subsequently suffered an infield relapse.
The development of ACM in CTT recipients resulted in substantial morbidity and mortality. Poor results were obtained with standard surgery and radiotherapy. Treatment modalities for and the underlying pathobiology of ACM in organ transplant recipients require detailed research if improved outcomes are to be achieved.
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