Haematology Section, Division of Experimental Medicine, Department of Medicine, Imperial College, London, UK.
Leukemia. 2012 Mar;26(3):422-3. doi: 10.1038/leu.2011.224. Epub 2011 Aug 26.
Risk of developing some cancers is markedly increased in settings of immune suppression including after solid organ transplants and in persons with inherited immune-deficiency disorders and those with HIV-1 infection. These cancers include lymphomas, melanoma and non-melanoma skin cancers, kidney and cervical cancers, Kaposi sarcoma and neuroblastoma. There are no reports of an increased acute myeloid leukemia (AML) in settings of immune suppression. This is curious because some data suggest the immune suppression may be important in increasing AML risk in experimental settings, and that immune stimulation may be useful in treating AML. To see whether immune suppression is correlated with an increased risk of developing AML, we analyzed data from 248224 recipients of kidney (N=217219) and heart (N=31005) transplants. Among the kidney transplant recipients, the standardized incidence ratio (SIR) for developing AML was 1.90 (95% confidence interval, 1.4-2.4; P<0.001). Among the heart transplant recipients, the SIR was 5.1 (3.4-7.1; P<0.001). These data suggest immune suppression increases risk of developing AML and that this risk is even higher, following intense prolonged immune suppression. Implications for AML development and therapy are discussed.
在免疫抑制环境中，某些癌症的发病风险显著增加，包括实体器官移植后、遗传性免疫缺陷疾病患者以及人类免疫缺陷病毒 1 型感染者。这些癌症包括淋巴瘤、黑色素瘤和非黑色素瘤皮肤癌、肾癌和宫颈癌、卡波西肉瘤和神经母细胞瘤。免疫抑制环境中没有急性髓系白血病（AML）发病率增加的报告。这很奇怪，因为一些数据表明，免疫抑制可能在实验环境中增加 AML 风险方面很重要，免疫刺激可能对治疗 AML 有用。为了观察免疫抑制是否与 AML 发病风险增加相关，我们分析了 248224 例接受肾（N=217219）和心脏（N=31005）移植的受者的数据。在肾移植受者中，AML 的标准化发病比（SIR）为 1.90（95%置信区间，1.4-2.4；P<0.001）。在心脏移植受者中，SIR 为 5.1（3.4-7.1；P<0.001）。这些数据表明，免疫抑制会增加 AML 的发病风险，而且在强烈和长期的免疫抑制后，这种风险更高。讨论了对 AML 发展和治疗的影响。
