PROSPECTIVE EVALUATION OF MALIGNANT NEOPLASMS IN CARDIAC TRANSPLANT RECIPIENTS UNIFORMLY TREATED WITH PROPHYLACTIC ANTILYMPHOCYTE GLOBULIN

Although there is convincing evidence. that prophylactic administratio n of high doses of the monoclonal antibody OKT3 predisposes patients t o an increased prevalence of early posttransplantation malignancy, par ticularly posttransplantation lymphoproliferative disease, it is indet erminate whether polyclonal antilymphocyte globulin poses a similar ha zard. We reviewed the outcome of 112 consecutive cardiac transplant re cipients who received uniform immunosuppression, including induction t herapy with antilymphocyte globulin, and were prospectively followed-u p for a median duration of 41.5 months (range 1 to 81 months). No pati ents had posttransplantation lymphoproliferative disease. Nine maligna nt neoplasms (8 %) were detected from 6 to 70 months after transplanta tion. Four patients with cutaneous neoplasms were alive and well at th e time this article was written. Three patients died of disseminated a denocarcinoma 6 months, 17 months, and 60 months after transplantation . One patient was undergoing treatment of Kaposi's sarcoma at the time this article was written, and another was undergoing treatment of tra nsitional bladder cell carcinoma. Actuarial survival for all patients was 88 % at 1 year and 79 % at 5 years. Moderate doses of induction an tilymphocyte globulin may facilitate rapid reduction of maintenance cy closporine and steroid doses, thereby decreasing the duration of inten se immunosuppression and lowering the risk of posttransplantation lymp hoproliferative disease. Testing this hypothesis would require the dev elopment of reliable and reproducible in vivo assays to prospectively assess immune status.