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Time trends in risk and risk determinants of non-Hodgkin lymphoma in solid organ transplant recipients

Fernberg, P ; Edgren, G ; Adami, J ; Ingvar, A LU orcid ; Bellocco, R ; Tufveson, G ; Höglund, P ; Kinch, A ; Simard, J F and Baecklund, E , et al. (2011) In American Journal of Transplantation 11(11). p.82-2472
Abstract

Organ transplantation increases risk of non-Hodgkin lymphoma (NHL), but long-term risk and time trends have seldom been evaluated. Immunosuppressive drug load is an important risk determinant, but the details are unclear. We studied NHL risk in a nationwide Swedish cohort of 11 081 graft recipients transplanted 1970-2008. Relative risks (RRs) were estimated within the cohort and versus the general population by age, sex, follow-up time and calendar period. NHL risk was also assessed by cumulative and average doses of immunosuppressive treatments in a nested case-control design throughout 1997 using conditional logistic regression. We observed 153 NHL cases during 97 853 years of follow-up. Compared with the general population, NHL risk... (More)

Organ transplantation increases risk of non-Hodgkin lymphoma (NHL), but long-term risk and time trends have seldom been evaluated. Immunosuppressive drug load is an important risk determinant, but the details are unclear. We studied NHL risk in a nationwide Swedish cohort of 11 081 graft recipients transplanted 1970-2008. Relative risks (RRs) were estimated within the cohort and versus the general population by age, sex, follow-up time and calendar period. NHL risk was also assessed by cumulative and average doses of immunosuppressive treatments in a nested case-control design throughout 1997 using conditional logistic regression. We observed 153 NHL cases during 97 853 years of follow-up. Compared with the general population, NHL risk was eightfold increased (RR 7.9; 95% confidence interval [CI] 6.6-9.4), and increased risks persisted after ≥15 years of follow-up among kidney (6.1; 95% CI 3.5-10) and nonkidney recipients (44; 14-103). Among nonkidney recipients, NHL risk was lower in the 2000s compared with the 1990s (0.5; 95% CI 0.3-1.0; p = 0.04). A high average dose of antithymocyte immunoglobulin (ATG) conferred an eightfold increased risk of NHL (OR 8.5; 95% CI 1.9-38). To conclude, posttransplant NHL risk decreased during the last decade among nonkidney recipients, possibly because of a more careful use of ATG, the introduction of new drugs, or both.

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type
Contribution to journal
publication status
published
subject
keywords
Adolescent, Adult, Aged, Antilymphocyte Serum/adverse effects, Case-Control Studies, Cohort Studies, Female, Follow-Up Studies, Humans, Immunosuppressive Agents/therapeutic use, Kidney Transplantation/adverse effects, Lymphoma, Non-Hodgkin/epidemiology, Male, Middle Aged, Risk, Sweden/epidemiology, T-Lymphocytes/immunology, Transplants/adverse effects
in
American Journal of Transplantation
volume
11
issue
11
pages
11 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:21883909
  • scopus:82555202505
ISSN
1600-6135
DOI
10.1111/j.1600-6143.2011.03704.x
language
English
LU publication?
no
additional info
©2011 The Authors Journal compilation © 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.
id
22652dd5-b3d0-4abf-abf1-68d075d658a0
date added to LUP
2020-11-16 10:03:19
date last changed
2022-04-19 02:19:21
@article{22652dd5-b3d0-4abf-abf1-68d075d658a0,
  abstract     = {{<p>Organ transplantation increases risk of non-Hodgkin lymphoma (NHL), but long-term risk and time trends have seldom been evaluated. Immunosuppressive drug load is an important risk determinant, but the details are unclear. We studied NHL risk in a nationwide Swedish cohort of 11 081 graft recipients transplanted 1970-2008. Relative risks (RRs) were estimated within the cohort and versus the general population by age, sex, follow-up time and calendar period. NHL risk was also assessed by cumulative and average doses of immunosuppressive treatments in a nested case-control design throughout 1997 using conditional logistic regression. We observed 153 NHL cases during 97 853 years of follow-up. Compared with the general population, NHL risk was eightfold increased (RR 7.9; 95% confidence interval [CI] 6.6-9.4), and increased risks persisted after ≥15 years of follow-up among kidney (6.1; 95% CI 3.5-10) and nonkidney recipients (44; 14-103). Among nonkidney recipients, NHL risk was lower in the 2000s compared with the 1990s (0.5; 95% CI 0.3-1.0; p = 0.04). A high average dose of antithymocyte immunoglobulin (ATG) conferred an eightfold increased risk of NHL (OR 8.5; 95% CI 1.9-38). To conclude, posttransplant NHL risk decreased during the last decade among nonkidney recipients, possibly because of a more careful use of ATG, the introduction of new drugs, or both.</p>}},
  author       = {{Fernberg, P and Edgren, G and Adami, J and Ingvar, A and Bellocco, R and Tufveson, G and Höglund, P and Kinch, A and Simard, J F and Baecklund, E and Lindelöf, B and Pawitan, Y and Smedby, K E}},
  issn         = {{1600-6135}},
  keywords     = {{Adolescent; Adult; Aged; Antilymphocyte Serum/adverse effects; Case-Control Studies; Cohort Studies; Female; Follow-Up Studies; Humans; Immunosuppressive Agents/therapeutic use; Kidney Transplantation/adverse effects; Lymphoma, Non-Hodgkin/epidemiology; Male; Middle Aged; Risk; Sweden/epidemiology; T-Lymphocytes/immunology; Transplants/adverse effects}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{82--2472}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{American Journal of Transplantation}},
  title        = {{Time trends in risk and risk determinants of non-Hodgkin lymphoma in solid organ transplant recipients}},
  url          = {{http://dx.doi.org/10.1111/j.1600-6143.2011.03704.x}},
  doi          = {{10.1111/j.1600-6143.2011.03704.x}},
  volume       = {{11}},
  year         = {{2011}},
}