WESTPORT, CT (Reuters Health) – Donor-derived small cell lung cancer and ectopic adrenocorticotropic hormone (ACTH) production can occur after kidney transplantation, according to a case report published in the November 1st issue of Cancer.
Dr. Mark R. Albertini and colleagues, from the University of Wisconsin at Madison, describe a 25-year-old woman who presented with Cushing syndrome 32 months after undergoing kidney transplantation. The donor had been diagnosed with small cell lung cancer 22 months earlier.
Further work-up revealed that the woman had donor-derived small cell lung cancer of the transplanted kidney. Extensive disease involving the liver and retroperitoneum was also noted.
Findings from studies of donor-derived malignancies have shown that discontinuation of immunosuppressive agents often causes complete tumor rejection. In the current case, however, the cancer progressed and cortisol levels remained elevated despite cessation of these agents.
The authors believe that this lack of tumor regression may have been "due in part to persistent ectopic ACTH production resulting in suppression of an allograft rejection response."
After receiving six cycles of cisplatin and etoposide, the patient's hypercortisolemia resolved and her cancer achieved complete remission. At latest follow-up, the patient's cancer remained in complete remission 1 year after completing chemotherapy.
Cancer 2001;92:2429-2434.
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