INTRODUCTION AND AIMS: K highly affects long-term survival of RT pts. Many factors, among those immunosuppressive therapy and age of the pts, are important. Due to their anti-proliferative and anti-angiogenetic properties, m-Tor inhibitors represent an option to reduce the risk of K (Kauffman et al. Transplantation 2005). Aim of the study was to assess and to quantify the effect of different therapeutic schemes, with or without SRL, on the onset of K in RT pts (May 1997-first pt on therapy with SRL- to December 2005). METHODS: 851 consecutive pts (median age at transplant: 50.9 yrs, range 13-75 yrs, median f-up: 56.1 mos, range 0.5-119.4 mos, M/F ratio: 2/1) were divided into 5 groups considering the use of SRL as stratifying variable. RESULTS: 68/851 pts developed at least one K (7.99%). Median interval to K since transplant was 25.1 mos (range 1.5-97.2, mean 32.425). Age at K onset: median 57.6 yrs (range 18.8-73, mean 56.110.8). The types of K were: skin (39.7%), solid (36.76%), lymphoproliferative (14.7%) and Kaposi sarcoma (skin and/or visceral 8.8%). Specific therapy for each K was adopted according to standard criteria. Among 68 pts who developed K, only one was assuming SRL at K onset. Only in 1/37 pts (2.7%), who were on SRL during all the follow-up (group 1), was noted a K (spinalioma; no recurrence after excision). 62/742 (8.3%) pts never on SRL (group 3 + 21 pts in whom SRL was initiated after K onset) developed a K after transplantation. The odds ratio for K no SRL vs SRL therapy was 3.3.Among 68 pts with K, 21 were shifted to SRL and 47 not. The K recurrence rate was respectively 10.5 % vs 14.6 %; no second K, different from the first one, was recorded in the SRL group; 1 occurred in the no SRL group. Overall mortality was 38/851 = 4.4% (26% pts due to K, 74% pts due to cardiovascular or infectious disease). CONCLUSIONS: Our results suggest a protective role of SRL in the primary prevention of post-transplant K and recommend the shift to m-TOR inhibitors minimising CNI doses (beside to the standard therapy). On this basis, our strategy is now and for the next future to convert to mTOR inhibitors pts with K or at high risk for K (K in situ/precancerosis; to May 2008, 54 pts).
Incidence of cancer (K) in patients with or without sirolimus (SRL): a monocentric analysis on 851 renal transplant patients (RT)
SEGOLONI, Giuseppe;BUSSOLINO, Stefania;FOP, FABRIZIO;VIGOTTI, FEDERICA NEVE;ARIAUDO, CLAUDIA;LAVACCA, ANTONIO;
2009-01-01
Abstract
INTRODUCTION AND AIMS: K highly affects long-term survival of RT pts. Many factors, among those immunosuppressive therapy and age of the pts, are important. Due to their anti-proliferative and anti-angiogenetic properties, m-Tor inhibitors represent an option to reduce the risk of K (Kauffman et al. Transplantation 2005). Aim of the study was to assess and to quantify the effect of different therapeutic schemes, with or without SRL, on the onset of K in RT pts (May 1997-first pt on therapy with SRL- to December 2005). METHODS: 851 consecutive pts (median age at transplant: 50.9 yrs, range 13-75 yrs, median f-up: 56.1 mos, range 0.5-119.4 mos, M/F ratio: 2/1) were divided into 5 groups considering the use of SRL as stratifying variable. RESULTS: 68/851 pts developed at least one K (7.99%). Median interval to K since transplant was 25.1 mos (range 1.5-97.2, mean 32.425). Age at K onset: median 57.6 yrs (range 18.8-73, mean 56.110.8). The types of K were: skin (39.7%), solid (36.76%), lymphoproliferative (14.7%) and Kaposi sarcoma (skin and/or visceral 8.8%). Specific therapy for each K was adopted according to standard criteria. Among 68 pts who developed K, only one was assuming SRL at K onset. Only in 1/37 pts (2.7%), who were on SRL during all the follow-up (group 1), was noted a K (spinalioma; no recurrence after excision). 62/742 (8.3%) pts never on SRL (group 3 + 21 pts in whom SRL was initiated after K onset) developed a K after transplantation. The odds ratio for K no SRL vs SRL therapy was 3.3.Among 68 pts with K, 21 were shifted to SRL and 47 not. The K recurrence rate was respectively 10.5 % vs 14.6 %; no second K, different from the first one, was recorded in the SRL group; 1 occurred in the no SRL group. Overall mortality was 38/851 = 4.4% (26% pts due to K, 74% pts due to cardiovascular or infectious disease). CONCLUSIONS: Our results suggest a protective role of SRL in the primary prevention of post-transplant K and recommend the shift to m-TOR inhibitors minimising CNI doses (beside to the standard therapy). On this basis, our strategy is now and for the next future to convert to mTOR inhibitors pts with K or at high risk for K (K in situ/precancerosis; to May 2008, 54 pts).
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