Development and incidence of cancer following cyclosporine therapy.

Eighty-seven organ transplant recipients developed 88 tumors after immunosuppression with CsA. The neoplasms showed important differences from those seen following conventional immunosuppressive therapy (CIT). Malignancies appeared an average of 14 months (range, 1 to 82) after CsA and 59 months (range, 1.0 to 225.5) after CIT. Cancers were particularly common among recipients of extrarenal organs. NHLs were the most common neoplasms comprising 52%, compared with 12% in CIT patients. They appeared an average of 8.5 months after transplantation, compared with an average of 41 months after CIT. Unlike NHLs in CIT patients, they more often involved lymph nodes, were more widespread, more frequently involved the small intestine, rarely involved the brain, were more likely to regress, and had a better prognosis following reduction of immunosuppressive therapy. Skin cancers (13% of cancers) were less common than in CIT patients (40%). Kaposi's sarcomas were more common (10% v 3%). Some tumors commonly seen after CIT, including in situ uterine cervical carcinomas and carcinomas of the vulva/perineum, have not occurred in CsA patients. In this small series, there was a surprising frequency of endocrine-related malignancies (ovarian, testicular, breast, and thyroid) and renal cell carcinomas. Longer follow-up and study of larger numbers of patients will determine whether differences from CIT patients will persist. Only seven (8%) patients were treated only with CsA, the remainder received other immunosuppressive agents, mainly prednisone. The malignancies probably are not specific to CsA therapy but appear to be a complication of immunosuppression per se.