Mahale P et al. – In this study, the authors analyzed primary central nervous system lymphoma (PCNSL) and systemic non–Hodgkin lymphoma (NHL) in solid organ transplant recipients (N = 288,029). The authors concluded that PCNSL risk is highly elevated in transplant recipients and carries a poor prognosis.

Methods

• Analysis of data from the United States transplant registry linked with 17 cancer registries (1987–2014).

Results

• Higher incidence of PCNSL (standardized incidence ratio = 65.1; n = 168) and NHL (standardized incidence ratio = 11.5; n = 2,043) in transplant recipients than the general population.
• PCNSL incidence was lower in liver recipients (adjusted incidence rate ratio [aIRR] = 0.52), similar in heart and/or lung recipients, and higher in other/multiple organ recipients (aIRR = 2.45) compared with kidney recipients.
• Higher incidence of PCNSL in Asians/Pacific Islanders than non–Hispanic whites (aIRR = 2.09); after induction immunosuppression with alemtuzumab (aIRR = 3.12), monoclonal antibodies (aIRR = 1.83), or polyclonal antibodies (aIRR = 2.03); in Epstein–Barr virus–seronegative recipients at the time of transplant and at risk of primary infection (aIRR = 1.95); and within the first 1.5 years of transplant (aIRR>2.00).
• PCNSL increased the risk of death (adjusted hazard ratio [aHR] = 11.79) or graft failure/retransplantation (aHR = 3.24).
• Recipients with PCNSL had higher mortality than those with systemic NHL (aHR = 1.48).