Hall Erin C, Engels Eric A, Pfeiffer Ruth M, Segev Dorry L
1 Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. 2 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD. 3 Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
Transplantation. 2015 May;99(5):1051-7. doi: 10.1097/TP.0000000000000449.
Induction immunosuppression is a mainstay of rejection prevention after transplantation. Studies have suggested a connection between antibody induction agents and cancer development, potentially limiting important immunosuppression protocols.
We used a linkage of U.S. transplantation data and cancer registries to explore the relationship between induction and cancer after transplantation. A total of 111,857 kidney recipients (1987-2009) in the Transplant Cancer Match Study, which links the Scientific Registry for Transplant Recipients and U.S. Cancer Registries, were included. Poisson regression models were used to estimate adjusted incidence rate ratios (aIRR) of non-Hodgkin lymphoma (NHL) and other cancers with increased incidence after transplantation (lung, colorectal, kidney, and thyroid cancers, plus melanoma).
Two thousand seven hundred sixty-three cancers of interest were identified. Muromonab-CD3 was associated with increased NHL (aIRR, 1.37; 95% CI, 1.06-1.76). Alemtuzumab was associated with increased NHL (aIRR, 1.79; 95% CI, 1.02-3.14), colorectal cancer (aIRR, 2.46; 95% CI, 1.03-5.91), and thyroid cancer (aIRR, 3.37; 95% CI, 1.55-7.33). Polyclonal induction was associated with increased melanoma (aIRR, 1.50; 95% CI, 1.06-2.14).
Our findings highlight the relative safety with regard to cancer risk of the most common induction therapies, the need for surveillance of patients treated with alemtuzumab, and the possible role for increased melanoma screening for those patients treated with polyclonal anti-T-cell induction.
诱导免疫抑制是移植后预防排斥反应的主要手段。研究表明抗体诱导剂与癌症发生之间存在关联，这可能会限制重要的免疫抑制方案。
我们利用美国移植数据与癌症登记系统的关联，来探究移植后诱导治疗与癌症之间的关系。纳入了移植癌症匹配研究中的111,857名肾移植受者（1987 - 2009年），该研究将移植受者科学登记系统与美国癌症登记系统相连接。采用泊松回归模型来估计非霍奇金淋巴瘤（NHL）以及移植后发病率增加的其他癌症（肺癌、结直肠癌、肾癌和甲状腺癌，外加黑色素瘤）的调整发病率比（aIRR）。
共识别出2763例感兴趣的癌症。莫罗单抗 - CD3与NHL发病率增加相关（aIRR，1.37；95%可信区间，1.06 - 1.76）。阿仑单抗与NHL发病率增加相关（aIRR，1.79；95%可信区间，1.02 - 3.14）、结直肠癌（aIRR，2.46；95%可信区间，1.03 - 5.91）以及甲状腺癌（aIRR，3.37；95%可信区间，1.55 - 7.33）。多克隆诱导与黑色素瘤发病率增加相关（aIRR，1.50；95%可信区间，1.06 - 2.14）。
我们的研究结果凸显了最常见诱导治疗在癌症风险方面的相对安全性、对接受阿仑单抗治疗患者进行监测的必要性，以及对接受多克隆抗T细胞诱导治疗患者增加黑色素瘤筛查的可能作用。
