Differential outcomes among immunosuppressed patients with merkel cell carcinoma

MacLean Cook, Kelsey Baker, Mary Redman, Kristina Lachance, MacKlin H. Nguyen, Upendra Parvathaneni, Shailender Bhatia, Paul Nghiem, Yolanda D. Tseng

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)82-88
Number of pages7
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Keywords

  • CLL
  • HIV/AIDS
  • immunosuppression
  • Merkel cell carcinoma
  • outcomes
  • solid organ transplant

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint

Dive into the research topics of 'Differential outcomes among immunosuppressed patients with merkel cell carcinoma'. Together they form a unique fingerprint.

Cite this