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The Community Oncologist: Duke Oncology Fellows Series

Malignancy After Solid Organ Transplantation: An Overview

^aDivisions of Hematology and Medical Oncology, ^bDepartment of Pathology, and ^cDivision of Medical Oncology; Duke University Medical Center, Durham, North Carolina, USA

Key Words. Solid organ transplantation • Kaposi sarcoma • Lymphoproliferative disorders • Etiology • Treatment

Correspondence: S. Yousuf Zafar, M.D., Divisions of Hematology and Medical Oncology, Duke University Medical Center, 508 Fulton Street (152), Durham, North Carolina 27705, USA. Telephone: 919-451-6726; pager: 919-970-9714; Fax: 919-681-7985; e-mail: yousuf.zafar{at}duke.edu

Received December 20, 2007; accepted for publication June 4, 2008; first published online in THE ONCOLOGIST Express on July 9, 2008.

Disclosure: This article discusses the use of acitretin (manufactured by Connetics) for prophylaxis of non-melanoma skin cancers; cyclophosphamide* (Bristol-Myers Squibb), adriamycin* (Pharmacia), prednisone* (Pfizer), vindesine (Lilly/EG Labo; not available in the U.S.), rituximab* (Genentech), and monoclonal anti-IL-6-antibody (multiple manufacturers) for post-transplant lymphoproliferative disorder (PTLD) (clinical trial); vincristine* (Lilly/Gensia Sicor) and bleomycin* (Bristol-Myers Squibb) for PTLD and Kaposi's sarcoma (KS); liposomal daunorubicin (Gilead) for KS (indicated for HIV-associated KS); paclitaxel (Bristol-Myers Squibb) for KS (indicated for AIDS-associated KS); imatinib (Novartis) and bevacizumab (Genentech) for KS; and matrix metalloproteinase inhibitor COL-3 (CollaGenex) for KS (clinical trial). (*Drugs marked with asterisks are indicated for use in malignant lymphomas generally, but no specific mention is made of PTLD.) The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

With improving survival following solid organ transplantation, clinicians must be aware of post-transplant complications. One increasingly frequent complication is the development of malignancy after transplantation. The most common malignancies encountered in the post–solid organ transplant setting are nonmelanoma skin cancers, post-transplant lymphoproliferative disorders, and Kaposi's sarcoma (KS). The pathogenesis of these tumors is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection. Treatment involves modification of the immunosuppressive drug regimen, resection of localized disease, and chemotherapy. We present the second reported case of a patient with lung transplantation who developed KS in the lung graft.