What is the association of immunosuppression and cancers?
It is important to note that a higher degree of immunosuppression confers a higher risk of malignancy. If the patient has an episode of acute rejection after transplant the treatment may include a second round of induction (lymphocyte-depleting) agents which increases the risk of future malignancies as well. CNIs are known to promote carcinogenesis. Azathioprine is associated with higher incidence of lymphoma and skin malignancies. Mycophenolate mofetil (MMF) and mycophenolate acid (MPA) were developed as anticancer drugs; however, there has been no difference in malignancy rates in patients on these drugs or not. However, if they are on the MMF or MPA, there is reduced rejection. mTOR inhibitors have a lower rate of malignancy. Reducing the risk of malignancy is one of the drivers pushing research into lighter immunosuppression protocols. However, this must be balanced against the risk of rejection.