Dose effects of cyclosporine and risk of cancer after heart transplantation

 

"Research Article"

American Journal of BioMedicine  Volume 3, Issue 2, pages 44-58, February 2015


Emily Jackson; Ju Song; Nayoung  Lee; David Viner; Rommel  Morgan; Siomar Statland; Anderson Bravo 

Abstract

Cyclosporine is a potent immunosuppressant medication that is considered a disease modifying antirheumatic drug (DMARD) and used as treatment options after heart transplantation to improved long-term survival rates. The increased incidence of cancer after heart transplantation is well established in the literature, yet outcome studies of quantitative dose of cyclosporin related to cancer remains unclear. This prospective study was conducted between 1998 and 2013 and is based on 102 patients who had previously received heart transplant. The study results indicate that the average patient age was 65 years and the interval between transplantation and the appearance of solid cancer was 4.5 years (P < 0.002; OR = 2.02; 95% CI [1.59–2.29], P < 0.0002). However, the current study does draw much-needed attention to concerns about overall immunosuppressant exposure and its relationship to long-term outcomes after solid organ transplantation to reduce future cancer risk and more research for alternative drug level monitoring are important.

Keywords: Cyclosporine; Cancer; Heart transplantation; Long-term outcomes


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References

1. Hunt SA. Taking heart-cardiac transplantation past, present, and future. N Engl J Med 2006;355(3):231–235. [PubMed]

2. Doesch AO, Müller S, Konstandin M, et al. Malignancies after heart transplantation: incidence, risk factors, and effects of calcineurin inhibitor withdrawal. Transplant Proc 2010;42(9):3694–3699. [PubMed]

3. Geissler EK. Fighting malignancy in organ transplant recipients. Transplant Proc 2009;41(6 suppl):S9–S12. [PubMed]

4. Stallone G, Schena A, Infante B, et al. Sirolimus for Kaposi’s sarcoma in renal-transplant recipients. N Engl J Med 2005;352(13):1317–1323. [PubMed]

5. Penn I. Cancers in cyclosporine-treated vs azathioprine-treated patients. Transplant Proc 1996;28:876-878. [PubMed]

6. Hojo M, Morimoto T, Malluccio M, et al. Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature 1999;397:530-534. [PubMed]

7. Morath C, Mueller M, Goldschmidt H, Schwenger V, Opelz G, Zeier M. Malignancy in renal transplantation. J Am Soc Nephrol 2004;15:1582-1588. [PubMed]

8. Helmschrott M, Beckendorf J, Akyol C, et al. Superior rejection profile during the first 24 months after heart transplantation under tacrolimus as baseline immunosuppressive regimen. Drug Des Devel Ther 2014;8:1307–1314. [Abstract/Full-Text]

9. Stehlik J, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Heart Transplant Report – 2011. J Heart Lung Transplant 2011;30(10):1078–1094. [PubMed]

10. Starzl TE, Fung J, Jordan M, et al. Kidney transplantation under FK 506. JAMA 1990;264(1):63–67. [PubMed]

11. Armitage JM, Kormos RL, Griffith BP, et al. A clinical trial of FK 506 as primary and rescue immunosuppression in cardiac transplantation. Transplant Proc 1991;23(1 Pt 2):1149–1152. [PubMed]

12. Ho ET, Wong G, Craig JC, Chapman JR. Once-daily extended-release versus twice-daily standard-release tacrolimus in kidney transplant recipients: a systematic review. Transplantation 2013;95(9):1120–1128. [PubMed]

13. Hemmens VJ, Moore DE. Photochemical sensitization by azathioprine and its metabolites. Azathioprine and nitroimidazole metabolites. Photochem Photobiol 1986;43(3):257–262. [PubMed]

14. Hodson EM, Jones CA, Webster AC, et al. Antiviral medications to prevent cytomegalovirus disease and early death in recipients of solid-organ transplants: a systematic review of randomised controlled trials.Lancet 2005;365(9477):2105–2115.

15. Opelz G, Döhler B. Lymphomas after solid organ transplantation: a collaborative transplant study report. Am J Transplant 2004;4(2):222–230. [PubMed]

16. Penn I. Occurrence of cancers in immunosuppressed organ transplant recipients . Clin Transpl 1998;10:147–158.

17. Swinnen LJ. Organ transplant-related lymphoma. Curr Treat Options Oncol 2001;2 :301–308. [PubMed]

18. Ye F, Ying-Bin X, Yu-Guo W, Hetzer R. Tacrolimus versus cyclosporine microemulsion for heart transplant recipients: a meta-analysis. J Heart Lung Transplant 2009;28(1):58–66. [PubMed]

19. Ekberg H, Tedesco-Silva H, Demirbas A, et al. ELITE-Symphony Study Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med 2007;357(25):2562–2575.

20. Meiser BM, Groetzner J, Kaczmarek I, et al. Tacrolimus or cyclosporine: which is the better partner for mycophenolate mofetil in heart transplant recipients? Transplantation 2004;78(4):591–598. [PubMed]

21. Stewart S, Winters GL, Fishbein MC, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant 2005;24(11):1710–1720. [PubMed]

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