Differential Outcomes Among Immunosuppressed Patients With Merkel Cell Carcinoma: Impact of Immunosuppression Type on Cancer-specific and Overall Survival. (January 2019)

• Record Type: Journal Article
• Authors: Cook, Maclean; Baker, Kelsey; Redman, Mary; Lachance, Kristina; Nguyen, Macklin H.; Parvathaneni, Upendra; Bhatia, Shailender; Nghiem, Paul; Tseng, Yolanda D.
• Is Part Of: American journal of clinical oncology. Volume 42:Number 1(2019)
• Publication Date: 2019-01
• Subjects: Merkel cell carcinoma -- immunosuppression -- HIV/AIDS -- CLL -- solid organ transplant -- outcomes; Cancer -- Treatment -- Periodicals; Oncology -- Periodicals; Tumors -- Periodicals; 616.994005
• DOI: 10.1097/COC.0000000000000482
• Languages: English
• ISSNs: 0277-3732

Abstract

Abstract : Objectives: Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin cancer with higher incidence among whites, elderly, and immunosuppressed patients. Although immunosuppressed MCC patients are at higher risk of recurrence and MCC-related death, it is unknown whether immunosuppression type is associated with differential outcomes. Materials and Methods: We retrospectively evaluated 89 nonmetastatic MCC patients with a diagnosis of chronic immunosuppression. Immunosuppression was categorized as chronic lymphocytic leukemia (31% of cohort), other hematologic malignancies (18%), solid organ transplant (21%), autoimmune disease (21%), and human immunodeficiency virus acquired deficiency syndrome (8%). Progression-free survival (PFS) and MCC-specific survival (MSS) were estimated with the cumulative incidence function. Overall survival (OS) was estimated by the Kaplan-Meier method. Results: With a median follow-up of 52 months, 53 deaths occurred (42 from MCC, 7 unknown, and 4 non-MCC). Two-year PFS, MSS, and OS were 30%, 55%, and 52%, respectively. Human immunodeficiency virus/acquired deficiency syndrome and solid organ transplant patients were diagnosed with MCC at a younger age (median 55 and 59 y, respectively) and with more advanced stage disease compared with other immunosuppressed subgroups. PFS did not significantly differ among the 5 immunosuppression subgroups ( P =0.30), but significant differences were observed in MSS and OS (both P =0.01). Controlling for potential confounders for OS, including age and stage, immunosuppression type was still significantly associated with risk of death ( P =0.01). Conclusions: Among immunosuppressed MCC patients, recurrent MCC is the major cause of mortality. The risk of death from MCC differs among immunosuppression types, suggesting important biological differences in host-tumor immune interactions. Abstract : Supplemental Digital Content is available in the text.