De novo cancer in cyclosporine‐treated and non‐cyclosporine‐treated adult primary renal allograft recipients

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Abstract
We compared the incidence of de novo tumors developing in 1165 primary adult renal allograft recipients treated with azathioprine (AZA)‐ prednisone (Pred)‐antilymphocyte globulin (ALG) (CONV group) with that in 722 patients receiving cyclosporine (CSA) as part of double (CSA‐ Pred), triple (CSA‐Pred‐AZA), or quadruple‐therapy (CSA‐Pred‐AZA‐ ALG) protocols. Mean±SD follow‐up was 9.5±6.4 years for the CONV group and 6.2±2.7 years for the CSA group. Overall, 124 patients (10.6%) in the CONV group and 34 patients (4.7%) in the CSA group developed malignancies, with nonmelanoma skin cancers and lymphomas comprising 55% and 13% of cancers in the CONV group and 65% and 3% of cancers in the CSA group, respectively. There were no significant differences in overall cancer (p=0.41) or skin cancer (p=0.97) incidence between non‐CSA‐ treated and CSA‐treated patients by Kaplan‐Meier life‐table analysis; however, CONV‐treated patients demonstrated a higher incidence of lymphoma (p=0.05). The mean (SD) time to overall and skin cancer occurrence was significantly shorter in the CSA group: 37 +22 versus 90+ 52 months (pde novo neoplasms and the much larger group who did not. In conclusion, we find no significant differences in overall or skin cancer incidence but a decrease in lymphoma incidence in primary adult renal allograft recipients following the introduction of CSA at our institution. Longer follow‐up of renal allograft recipients on CSA therapy may reveal changes in the pattern of cancer development.