Cancer in patients with kidney diseases, patients on dialysis and patients transplanted with special emphasis on non-Hodgkin's lymphomas, and a possible virus etiology. Predictive, preventing and treating strategies.

SAB Birkeland, D.M.Sc.

Odense University Hospital, Odense C, DK-5000 Odense C Denmark

Aim The aim is to combine knowledge from a series of cancer incidence studies in patients with kidney diseases, on dialysis or transplanted to look for a possible virus etiology. Methods Population-based cancer incidence studies were performed using nationwide registers on patients with kidney biopsies, patients on dialysis and patients transplanted, with patients linked by their unique personal identification number to the National Population Registry, the Danish Cancer Registry, the Danish National Hospital Register and the Danish Registers of Causes of Death. Epstein Barr Virus and interleukin analyses are performed in a population of transplanted patients in blood and tumors. Results Patients with a biopsy proven glomerulonephritis had a 2-3-fold excess of the expected (colon , lung, skin and lymphatic tissue), and non-Hodgkin's lymphomas were observed 6-8 times more than expected. Patients on dialysis had a small, significant excess cancer incidence (1.4-1.5) based on skin cancer and urinary system, and transplanted patients had a significant excess cancer incidence on 3.7 based on lip, skin, lung, female genital organs, urinary system and non-Hodgkin lymphomas. Epstein Barr Virus caused non-Hodgkin lymphomas in patients transplanted. Acyclovir prophylaxis is possible, prediction can be done through virus and interleukin analysis, and regression of lymphomas can be obtained by cessation of immunosuppression combined with antivirus drugs. Conclusions The excess cancer rate in transplanted patients is probably multifactorial but mayor culprits are the chronic antigenicity of the graft, the immunosuppression given and concomitant virus infections (of the herpes and papilloma groups). Cancer excess in glomerulonephritidis was seen in cases with a known or suspected virus etiology. If further substantiated this could implement new treatment strategies in patients with kidney diseases at any level.

KEY WORDS: Cancer, non-Hodgkins lymphoma, Epstein-Barr virus, dialysis, transplantation.

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Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Viral Oncogenesis.