Incidence and outcomes of primary central nervous system lymphoma in solid organ transplant recipients

Primary central nervous system lymphoma ( PCNSL ) risk is greatly increased in immunosuppressed human immunodeficiency virus–infected people. Using data from the US transplant registry linked with 17 cancer registries (1987‐2014), we studied PCNSL and systemic non‐Hodgkin lymphoma ( NHL ) in 288 029 solid organ transplant recipients. Transplant recipients had elevated incidence for PCNSL compared with the general population (standardized incidence ratio = 65.1; N = 168), and this elevation was stronger than for systemic NHL (standardized incidence ratio=11.5; N = 2043). Compared to kidney recipients, PCNSL incidence was lower in liver recipients (adjusted incidence rate ratio [ aIRR ] = 0.52), similar in heart and/or lung recipients, and higher in other/multiple organ recipients ( aIRR  = 2.45). PCNSL incidence was higher in Asians/Pacific Islanders than non‐Hispanic whites ( aIRR  = 2.09); after induction immunosuppression with alemtuzumab ( aIRR  = 3.12), monoclonal antibodies ( aIRR  = 1.83), or polyclonal antibodies ( aIRR  = 2.03); in recipients who were Epstein‐Barr virus–seronegative at the time of transplant and at risk of primary infection ( aIRR  = 1.95); and within the first 1.5 years after transplant. Compared to other recipients, those with PCNSL had increased risk of death (adjusted hazard ratio [ aHR ] = 11.79) or graft failure/retransplantation ( aHR  = 3.24). Recipients with PCNSL also had higher mortality than those with systemic NHL ( aHR  = 1.48). In conclusion, PCNSL risk is highly elevated among transplant recipients, and it carries a poor prognosis.