Cancer Immunotherapy in Solid Organ Transplanted Patients

Year 2020, Volume: 10 Issue: 2, 87 - 96, 26.08.2020

Ali Abdi Fatma Betül Öktelik Mehtap Doğruel Biçer Ali Osman Gürol

https://doi.org/10.26650/experimed.2020.0036

Abstract

Solid-organ transplantation, which began as an experimental procedure in the 20th century, has become an established, definitive, and practicable treatment option for patients with organ dysfunction. However, since the pioneering days of solid organ transplantation, it has been recognized that transplant recipients have an elevated risk of developing cancer. When compared with healthy individuals, lung, liver, heart, and kidney transplant recipients are at a higher risk for various cancers. Both chronic immunosuppression and environmental factors are implicated in cancer development in the transplant recipients. A history of malignancy and genetic predisposition are additional risk factors. Post-transplant malignancies are thought to develop by three mechanisms: de novo development, donor-related transmission, and recurrence of a recipient’s pre-transplant malignancy. Other known risk factors are environmental exposure, genetic predisposition, and infection with oncogenic viruses. It is worth noting that many of these risk factors are linked with the use of immunosuppression drugs. These agents play a huge role in the development of cancer through the loss of the immunosurveillance process and the requirement of patients to receive lifelong immunosuppressive therapy to prevent rejection of the donor organ. Even though the field of anticancer therapy is continually developing, there is limited data on the use of anticancer drugs in transplant recipients. Hence, this review attempts to explain the role of immunosuppression in cancer development and the cancer immunotherapy strategies to be adopted while caring for transplant recipients.

Keywords

Solid-organ transplantation, cancer, immunosuppression, immunotherapy

Solid-Organ Transplantasyonu Olan Hastalarda Kanser İmmünoterapisi

Abstract

Solid organ transplantasyonu 20. yüzyılda deneysel bir yaklaşımdan ortaya çıkmış ve organ fonksiyon bozukluğu olan hastalar için yerleşik ve pratik bir kesin tedavi seçeneği haline gelmiştir. Terminal olarak kabul edilen veya bir hastanın yaşam kalitesinde önemli bir bozulma ile ilişkili hastalıklar için hayat kurtarıcı tedaviler sunmaktadır. Solid organ transplantasyonunun ilk günlerinden beri, solid transplant alıcılarının kanser geliştirme riskinin yüksek olduğu kabul edilmektedir. Toplumda sağlıklı bireylere göre karşılaştırıldığında akciğer, karaciğer, kalp veya böbrek nakli alıcıları çeşitli kanserler için daha fazla risk taşımaktadır. Kronik immünsüpresyon ve çevresel faktörler, alıcılarda kanser gelişiminde rol oynamaktadır. Ayrıca daha önce malignite öyküsü olması ve genetik yatkınlık önemli riskler arasındadır. Transplantasyon sonrası malignitelerin üç mekanizma ile geliştiği düşünülmektedir: de novo gelişim, donör ile ilgili bulaşma ve alıcının transplantasyon öncesi malignitesinin tekrarlaması. Bilinen risk faktörleri genetik, çevresel maruziyetler, onkojenik virüslerle enfeksiyonlardır. Ancak bu risklerin çoğu immünsüpresif ajanların rolüne odaklanmıştır. Bu ajanlar, immün gözetim sürecinin kaybını ve donör organın reddini önlemeyi hedefler. Hastaların ömür boyu immün sistemini baskılayıcı tedavi alma gereksinimi kanserin gelişiminde büyük rol oynamaktadır. Ayrıca, antikanser ajan alanı, transplantasyon alıcılarındaki kullanımla ilgili verilerin sınırlı olmasıyla birlikte, sürekli olarak genişlemekte ve gelişmektedir. Bu nedenle, bu derlemenin amacı, kanser gelişiminde immünsüpresyonun rolünü açıklamak ve transplant alıcılarının bakımı için kanser immünoterapi stratejilerini gözden geçirmektir.

Keywords

Solid organ transplantasyonu, kanser, immünsüpresyon, immünoterapi

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