Aggressive cutaneous malignancies following cardiothoracic transplantation- The Australian experience

BACKGROUND, The development of malignancies in recipients of a cardiothorac ic transplant (CTT)-that is, heart, lung, or heart and lung recipients-is o f concern. Cutaneous and lymphoproliferative malignancies comprise the two major groups of malignancies encountered. A small subgroup of patients will develop potentially life-threatening aggressive cutaneous malignancies (AC M); these are poorly defined and documented in the literature. The authors report the results for 619 CTT recipients from a single institution. METHODS. Between 1984 and 1995, 619 recipients received a CTT. With a minim um follow-up of 2 years, 66 patients (10.7%) were diagnosed with a major ma lignancy, and 27 of these 66 patients developed ACM. ACM were defined as ha ving one or more of the following characteristics: local invasion and/or re gional metastases at diagnosis, poor differentiation, and locoregional and/ or systemic relapse following therapy. All malignant melanomas were conside red ACM. Data on malignancy occurrence were documented in the clinical note s of the heart and lung transplant unit. A retrospective analysis was under taken from these notes. RESULTS. Tumor histology was predominantly poorly differentiated squamous c ell carcinoma (55%) (SCC) and malignant melanoma (30%) (MM). No patient dev eloped Kaposi sarcoma (KS). The median time from transplant to diagnosis of ACM was 52 months (range, 8-127 months). Thirteen of 27 patients have died ; 10 of them died of metastatic disease. The mean time to death was 20 mont hs (range, 8-54 months). Of 14 patients alive, 5 have disease. All but one of the 19 patients diagnosed with nonmelanoma ACM received radiotherapy, ei ther as part of initial treatment or on relapse. Eight patients have subseq uently suffered an infield relapse. CONCLUSIONS. The development of ACM in CTT recipients resulted in substanti al morbidity and mortality. Poor results were obtained with standard surger y and radiotherapy. Treatment modalities for and the underlying pathobiolog y of ACM in organ transplant recipients require detailed research if improv ed outcomes are to be achieved. (C) 1999 American Cancer Society.