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Cancer risks along the disease trajectory in antineutrophil cytoplasmic antibody associated vasculitis

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Abstract

This review appraises the current literature on carcinogenic risks in anti-neutrophilic cytoplasmic autoantibody (ANCA) associated vasculitis (AAV). Patients with AAV are often at increased risk of developing non-melanoma skin carcinomas (NMSCs), haematological malignancies, bladder, breast, lung, prostate, and colorectal carcinomas. Reported cancer incidence in these patients ranged from 10 to 26%. Cancer risks at the time of diagnosis of AAV and disease outcomes along the trajectory of AAV that may lead to chronic kidney disease (CKD); dialysis and transplantation are summarized. Inherent carcinogenic risks as part of immunosuppressive treatment in AAV are further detailed with considerations on specific malignancy risks of therapeutic agents used. Challenges that contribute to malignancy risk include a high relapse rate of AAV and prolonged exposure to immunosuppressants. The incidence of malignancy increases significantly after 5 years of immunosuppressant exposure though risks in the earlier years have also been described. Following renal transplantation, there is limited information available on risk of malignancy. Thoughtful use of immunosuppressants, modification of lifestyle, and environmental factors, as well as adopting appropriate cancer screening will likely influence malignancy risk in individuals with AAV.

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Authors and Affiliations

  1. School of Medicine, Griffith University, Gold Coast, Queensland, 4222, Australia

    Zaw Thet, Alfred K. Lam, Dwarakanathan Ranganathan & Tien K. Khoo

  2. Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia

    Zaw Thet

  3. Department of Nephrology, Metro North Hospital and Health Service, Herston, Queensland, Australia

    Dwarakanathan Ranganathan

  4. Department of Oncology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia

    Soe Yu Aung

  5. School of Medicine, University of Queensland, Rockhampton, Queensland, Australia

    Soe Yu Aung

  6. School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia

    Tien K. Khoo

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  2. Alfred K. Lam
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Thet, Z., Lam, A.K., Ranganathan, D. et al. Cancer risks along the disease trajectory in antineutrophil cytoplasmic antibody associated vasculitis. Clin Rheumatol 39, 2501–2513 (2020). https://doi.org/10.1007/s10067-020-05055-x

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