Is cancer really THAT much of a risk on immunosuppression?

[DialysisGoneFOREVER]

I'm talking about the usual 3 drug protocol after a kidney transplant. I asked my transplant coordinator after my 1st transplant and she said the transplant patients there didn't have any cancer even after some were on immunosuppression for many years. I read it's only a 3% increased risk of skin cancer on immunosuppression.  I mean it can't be much of a risk otherwise they wouldn't even do transplants.

What do you guys think and what have you found out?

[Michael Murphy]

From what I understand for me transplant is not a option because every other year or so one of the many moles I got from sunburn as a youth turn to melanoma.  If that would occur after a transplant the window to catch and remove the cancer would be small.  It's obvious that a transplant is a good thing but not if it kills you.  I can still hear my father yelling turn off the tv and go out and get some sun it's good for you. 

[Simon Dog]

The transplant team I deal with told me "increased risk of non-melanoma skin cancer; 10% total risk for lymphoma, but that some immunisuppresent lymphomas recede when the immunosuppresent is with drawn (yikes!)".;

[Zach]

New England Journal of Medicine
July 26, 2012DOI: 10.1056/NEJMoa1204166

Sirolimus and Secondary Skin-Cancer Prevention in Kidney Transplantation

Abstract:

BACKGROUND
Transplant recipients in whom cutaneous squamous-cell carcinomas develop are at high risk for multiple subsequent skin cancers. Whether sirolimus is useful in the prevention of secondary skin cancer has not been assessed.


METHODS
In this multicenter trial, we randomly assigned transplant recipients who were taking calcineurin inhibitors and had at least one cutaneous squamous-cell carcinoma either to receive sirolimus as a substitute for calcineurin inhibitors (in 64 patients) or to maintain their initial treatment (in 56). The primary end point was survival free of squamous-cell carcinoma at 2 years. Secondary end points included the time until the onset of new squamous-cell carcinomas, occurrence of other skin tumors, graft function, and problems with sirolimus.


RESULTS
Survival free of cutaneous squamous-cell carcinoma was significantly longer in the sirolimus group than in the calcineurin-inhibitor group. Overall, new squamous-cell carcinomas developed in 14 patients (22%) in the sirolimus group (6 after withdrawal of sirolimus) and in 22 (39%) in the calcineurin-inhibitor group (median time until onset, 15 vs. 7 months; P=0.02), with a relative risk in the sirolimus group of 0.56 (95% confidence interval, 0.32 to 0.98). There were 60 serious adverse events in the sirolimus group, as compared with 14 such events in the calcineurin-inhibitor group (average, 0.938 vs. 0.250). There were twice as many serious adverse events in patients who had been converted to sirolimus with rapid protocols as in those with progressive protocols. In the sirolimus group, 23% of patients discontinued the drug because of adverse events. Graft function remained stable in the two study groups.


CONCLUSIONS
Switching from calcineurin inhibitors to sirolimus had an antitumoral effect among kidney-transplant recipients with previous squamous-cell carcinoma. These observations may have implications concerning immunosuppressive treatment of patients with cutaneous squamous-cell carcinomas. (Funded by Hospices Civils de Lyon and others; TUMORAPA ClinicalTrials.gov number, NCT00133887.)

For the full article:
http://www.nejm.org/doi/full/10.1056/NEJMoa1204166#t=articleTop

[coravh]

Many years ago (my numbers may be wrong now) I was told by a pharmacist that the odds of getting skin cancer (in my area - Canada) was about 1 - 2%. And that with the immuno drugs that was roughly double  at between 3 and 5%. So the odds (at least for the skin cancer) are relatively speaking fairly low. It also depends on what you are doing and how yoiu live. I have a friend who had a cancerous legion removed from his chest about 3 years post transplant. But then again, he was riding 100 miles on his bike in the summers a couple of times per week and not always applying a lot of sunscreen to his chest (where the spot was removed).

The sad truth is that just like rejection, they don't really know why some get cancer and some don't. I have a friend who was diagnosed with lymphoma 2 years after tx. He's pretty angry, but this wasn't really predictable and out of the 25 or so transplant patients I know locally, I know of 2 who have had lymphoma. We all just have to do the best we can. I have to say that my odds of death were much higher while on dialysis - I didn't do well.

[DialysisGoneFOREVER]

I checked with my nephrologist and he follows 22 transplant patients from 6 to 27 years post transplant. Only ONE got cancer but they got treated for lymphoma and now they're OK! NONE have skin cancer. I know this is just a sample size but 0 out of 22 having skin cancer and 1 out of 22 having lymphoma are pretty good odds against getting cancer!

[coravh]

I checked with my nephrologist and he follows 22 transplant patients from 6 to 27 years post transplant. Only ONE got cancer but they got treated for lymphoma and now they're OK! NONE have skin cancer. I know this is just a sample size but 0 out of 22 having skin cancer and 1 out of 22 having lymphoma are pretty good odds against getting cancer!

Those #s are about what I've seen among personal (in town) transplant friends. As with everything else, we just have to work to remain positive, do what we can to prevent problems, and face and fight whatever bad stuff comes along.

Best of luck to you.

[DialysisGoneFOREVER]

Yes indeed.

We need to exercise, eat healthy, and keep a healthy weight as well as have a positive attitude!

[maxwood]

"We need to exercise, eat healthy, and keep a healthy weight as well as have a positive attitude!."

I hate to be a contrarian, BUT I'm not sure any of that makes any difference!  I was 69, never spent a day in any hospital, ran 20 to 30 miles a week, watched what I ate and had done all of this for 35 years.  In early 2014 I was diagnosed with Mantle Cell Lymphoma that also took out my kidneys.  So, much for all the good living.  The only help it gave me was in being able to tolerate chemo a little better than a couch potato.

[nursey66]

So sorry to hear that you had to go through that. I never heard of that type of cancer.

[kickingandscreaming]

I hate to be a contrarian, BUT I'm not sure any of that makes any difference!  I was 69, never spent a day in any hospital, ran 20 to 30 miles a week, watched what I ate and had done all of this for 35 years.  In early 2014 I was diagnosed with Mantle Cell Lymphoma that also took out my kidneys.  So, much for all the good living.  The only help it gave me was in being able to tolerate chemo a little better than a couch potato.

Similar story for my late husband.  He was Mr. Clean.  Was a vegetarian for years and years, meditated an hour/day, race walked 2 hours/day, didn't smoke, didn't drink, etc. etc.  At the age of 61 he died of acute Leukemia.  As maxwood said, he did tolerate the chemo better than most people.  But he died all the same.  Way too young. I too have always been a pretty clean liver, and here I am with kidney failure.  Life is a crapshoot.

[cassandra]

Yes indeed.

We need to exercise, eat healthy, and keep a healthy weight as well as have a positive attitude!

I seriously fail to see how anyone can be for any amount of time on this planet and belief that. You are lucky or you are not.

[DialysisGoneFOREVER]

Yes indeed.

We need to exercise, eat healthy, and keep a healthy weight as well as have a positive attitude!

I seriously fail to see how anyone can be for any amount of time on this planet and belief that. You are lucky or you are not.

Luck is a factor but there is NO WAY you can say fitness and diet aren't important! Remember the saying USE IT OR LOSE IT!

[DialysisGoneFOREVER]

"We need to exercise, eat healthy, and keep a healthy weight as well as have a positive attitude!."

I hate to be a contrarian, BUT I'm not sure any of that makes any difference!  I was 69, never spent a day in any hospital, ran 20 to 30 miles a week, watched what I ate and had done all of this for 35 years.  In early 2014 I was diagnosed with Mantle Cell Lymphoma that also took out my kidneys.  So, much for all the good living.  The only help it gave me was in being able to tolerate chemo a little better than a couch potato.

I understand what you're saying but diet and fitness play SOME role you agree? You CANNOT think we'd be better off being 300 pound obese slobs who eat donuts, burgers, and hot dogs all day!!

[Deanne]

"We need to exercise, eat healthy, and keep a healthy weight as well as have a positive attitude!."

I hate to be a contrarian, BUT I'm not sure any of that makes any difference!  I was 69, never spent a day in any hospital, ran 20 to 30 miles a week, watched what I ate and had done all of this for 35 years.  In early 2014 I was diagnosed with Mantle Cell Lymphoma that also took out my kidneys.  So, much for all the good living.  The only help it gave me was in being able to tolerate chemo a little better than a couch potato.

There's no way to know, of course, but maybe if you hadn't lived such a healthy lifestyle for so long, you would have developed cancer much earlier in your life. I can't admit to being a dietary angel, but as much as I can, I'd rather err on the side of maintaining overall health and fitness to help manage the risks caused by the meds.