Abstract 15858: Does Switching to Proliferation Signal Inhibitors Decrease the Risk of Developing Subsequent Malignancies in Heart Transplant Patients?
Introduction: Malignancy is vast approaching as the leading cause of death late after heart transplantation. It is known that the current immunosuppression regimen consisting of tacrolimus/cyclosporine and mycophenolate is associated with increased risk of cancers. The use of proliferation signal inhibitors (PSI) has been associated with less cancer development particularly in specific tumors. We sought to determine if there is an association of the use of PSI in decreasing overall cancer risk.
Methods: Between 2004 and 2008 we assessed 16 heart transplant patients who were placed on PSI and compared cancer development based on conditional survival in the ensuing 5 years to those not on PSI (n=16). Patients were matched according to age, sex, time from transplant, and era.
Results: Patients were switched to PSI on an average of 0.9 ± 0.9 years after transplant. Those patients that were placed on PSI had a higher subsequent 5-year actuarial freedom from cancer development compared to those patients not on PSI (100.0% vs 77.7%, p=0.049). These specific cancers included: skin cancer (2), squamous cell cancer (2), auricular carcinoma (1), prostate cancer (1), and cranial meningioma (1). There was no difference in 5-year actuarial freedom from cardiac allograft vasculopathy (CAV) development between the CNI + MMF/AZA and CNI + PSI groups (81.3% vs 72.2%,p=0.683).
Conclusions: The use of PSI after heart transplantation appears to confer a protective effect against the development of malignancy. Larger number of patients are needed to confirm these observations.
Author Disclosures: J. Patel: Research Grant; Modest; Alexion Pharmaceuticals. M. Kittleson: None. S. Siddiqui: None. F. Liou: None. J. Yabuno: None. M. Merchant: None. D.H. Chang: Research Grant; Modest; TEVA sponsored DREAM HF trial. Other; Modest; Stock in AbbVie and Abbott Vascular. M. Hamilton: Speakers Bureau; Modest; Abbott Vascular. L. Czer: Research Grant; Modest; St. Jude Medical. J.A. Kobashigawa: Research Grant; Modest; Novartis, CareDx. Consultant/Advisory Board; Modest; TransMedics.
- © 2015 by American Heart Association, Inc.