Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
Am J Transplant. 2013 Jun;13(6):1523-32. doi: 10.1111/ajt.12234. Epub 2013 May 1.
Transplant recipients have elevated risk for plasma cell neoplasms (PCNs, comprising multiple myeloma and plasmacytoma), but little is known about risk factors in the transplant setting. Through linkage of the US solid organ transplant registry with 15 state/regional cancer registries, we identified 140 PCNs in 202 600 recipients (1987-2009). PCN risk was 1.8-fold increased relative to the general population (standardized incidence ratio [SIR] 1.80, 95%CI 1.51-2.12). Among cases, 102 were multiple myeloma (SIR 1.41) and 38 were plasmacytoma (SIR 7.06). PCN incidence increased with age, but due to the rarity of PCNs in younger people in the general population, SIRs were highest in younger transplant recipients (p = 0.03). PCN risk was especially high in recipients who were Epstein-Barr virus (EBV) seronegative at transplantation (SIR 3.93). EBV status was known for 18 tumors, of which 7 (39%) were EBV positive. Following liver transplantation, PCN risk was higher in recipients with cholestatic liver disease (SIR 2.78); five of these cases had primary biliary cirrhosis (PBC). A role for primary EBV infection after transplantation is supported by the increased PCN risk in young EBV seronegative recipients and the presence of EBV in tumors. PBC may be another risk factor, perhaps by causing chronic immune activation.
移植受者发生浆细胞肿瘤（PCN，包括多发性骨髓瘤和浆细胞瘤）的风险增加，但对于移植环境中的危险因素知之甚少。通过将美国实体器官移植登记处与 15 个州/地区癌症登记处相联系，我们在 202600 名受者（1987-2009 年）中确定了 140 例 PCN。PCN 风险比普通人群高 1.8 倍（标准化发病比 [SIR] 1.80，95%CI 1.51-2.12）。在病例中，102 例为多发性骨髓瘤（SIR 1.41），38 例为浆细胞瘤（SIR 7.06）。PCN 发病率随年龄增加而增加，但由于普通人群中年轻人 PCN 的罕见性，因此年轻移植受者的 SIR 最高（p=0.03）。移植时 EBV 血清阴性的受者 PCN 风险特别高（SIR 3.93）。已知 18 例肿瘤的 EBV 状态，其中 7 例（39%）为 EBV 阳性。肝移植后，胆汁淤积性肝病的受者 PCN 风险较高（SIR 2.78）；其中 5 例为原发性胆汁性肝硬化（PBC）。年轻 EBV 血清阴性受者中 PCN 风险增加以及肿瘤中存在 EBV 支持移植后原发性 EBV 感染的作用。PBC 可能是另一个危险因素，可能通过引起慢性免疫激活。
