Comprehensive Review of Post–Organ Transplant Hematologic Cancers

Vikas R. Dharnidharka

Disclosures

American Journal of Transplantation. 2018;18(3):537-549. 

In This Article

Abstract and Introduction

Abstract

A higher risk for a variety of cancers is among the major complications of posttransplantation immunosuppression. In this part of a continuing series on cancers posttransplantation, this review focuses on the hematologic cancers after solid organ transplantation. Posttransplantation lymphoproliferative disorders (PTLDs), which comprise the great majority of hematologic cancers, represent a spectrum of conditions that include, but are not limited to, the Hodgkin and non-Hodgkin lymphomas. The oncogenic Epstein-Barr virus is a key pathogenic driver in many PTLD cases, through known and unknown mechanisms. The other hematologic cancers include leukemias and plasma cell neoplasms (multiple myeloma and plasmacytoma). Clinical features vary across malignancies and location. Preventive screening strategies have been attempted mainly for PTLDs. Treatments include the chemotherapy regimens for the specific cancers, but also include reduction of immunosuppression, rituximab, and other therapies.

Introduction

The great advances in transplantation science have led to dramatic improvements in posttransplantation success, especially with regard to reduced early acute rejection rates and early posttransplantation allograft survival. Many organ transplant recipients now survive for prolonged periods of time, and most of them need continuous extrinsic immunosuppression throughout that period. This prolonged and nonspecific immunosuppression has led to a rise in prominence of a variety of posttransplantation cancers, highlighting in part the role of immune surveillance in cancer prevention.

In this continuing part of a series in the journal on cancers posttransplantation,[1] this review focuses on cancers of the hematologic system after solid organ transplantation. The review covers posttransplantation lymphoproliferative disorders (PTLDs), Hodgkin lymphoma (HL), non-Hodgkin lymphomas (NHL), leukemias (acute and chronic), and plasma cell neoplasms (multiple myeloma and plasmacytoma) after solid organ transplantation (SOT). Cancers of the hematopoietic system that lead to a hematopoietic stem cell transplantation (HSCT), or cancers after HSCT, are beyond the scope of this review article.

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