Increased Incidence of De Novo Malignancies Compared With Malignancy Recurrences in Survivors of Cancer Undergoing Heart Transplantation

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BACKGROUND: A proportion of cancer survivors (CS) with heart failure develop advanced heart failure. In select CS with advanced heart failure, heart transplantation (HT) remains the gold standard treatment. CS have been shown to have increased incidence of subsequent primary cancers (SPC). This study investigated the incidence and characteristics of SPC in CS undergoing HT at a high-volume HT center. METHODS: A retrospective analysis of adult CS (age≥18) who underwent HT at Columbia University Irving Medical Center between January 1, 2000, and August 1, 2020, was conducted. Patients with nonmelanoma skin cancer were excluded. Kaplan-Meier analysis was used to measure cancer-free survival. RESULTS: Of 1332 consecutive patients undergoing HT at our institution between January 1, 2000, and August 1, 2020, 104 patients were CS (7.8%). CS had improved survival compared with the non-CS group, with a 5-, 10-, and 15-year survival of 89%, 70%, and 60% in the CS group compared with 78%, 64%, and 41% in the non-CS group. Twenty-two (21.2%) developed SPC at a median of 4 years (interquartile range, 3-7.75) posttransplant. Eighteen of 22 SPC (82%) were de novo malignancies, and 4 were recurrences. CONCLUSIONS: CS are 4 times more likely to have de novo malignancies unrelated to their primary malignancy rather than a recurrence. Despite the high rate of SPC, survival in this cohort was comparable to contemporary survival in HT patients. Further studies are required to understand optimal prevention and screening for SPC in CS undergoing HT beyond recommendations in the general population.

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