Immunosuppression and Malignancy

Patients with immune deficiency are at increased risk for developing malignancy. The mechanism of oncogenesis is unknown, but the striking similarity between increased malignancies in immunosuppressed transplant recipients and patients with HIV suggests that immune function plays a vital role. In HIV, three types of cancer occur at markedly increased rates during later stages of the disease and are thus considered AIDS-defining malignancies. These include KS, non-Hodgkin’s lymphoma (NHL), and invasive cervical cancer. A metaanalysis comparing the incidence of cancer in patients with HIV/AIDS and immunosuppressed transplant recipients demonstrated a striking similarity in the pattern of increased rates of most types of cancer. Both groups had increased rates of AIDS-defining malignancies, Hodgkin’s lymphoma, squamous cell carcinoma of the lip, and nonmelanoma skin cancer. Non–AIDSdefining malignancies in patients with HIV also occur later in the disease course, often after the diagnosis of AIDS. These findings suggest that immune deficiency plays a role in the pathogenesis of cancer, although the mechanism of oncogenesis is unknown. There is no clear evidence linking immune depression with other types of head and neck cancer.



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