Cancer incidence in immunocompromised patients: a single-center cohort study

Sabrina Ilham, Connor Willis, Kibum Kim, Karen C. Chung, Brenda M. Wood, Malinda S. Tan, Chia Jie Tan, Danielle T. Nguyen, Diana I. Brixner, David D. Stenehjem

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4 Scopus citations


Background: Diminished immune defense plays an important role in cancer development. Cancer risk in immunocompromised patients may differ. Identifying individuals with elevated cancer risk can inform strategies for routine cancer screening. This study aimed to understand and compare cancer incidence and risk in three patient groups: recipients of solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT); diagnosis of primary or secondary immunodeficiency disorder (PID/SID); and recipients of tumor necrosis factor inhibitor (TNF-i) therapy. Methods: This retrospective cohort study used the University of Utah Health System database and Huntsman Cancer Institute tumor registry. Patients aged ≥18 years with SOT/HSCT, PID/SID or ≥ 3 months of TNF-i therapy were included. The date of transplant, diagnosis of PID/SID, or 1st TNF-i medication order date was defined as the index date. We calculated cumulative cancer incidence by Kaplan-Meier method. A Cox-proportional hazard regression model with a stepwise variable selection process was used to identify independent risk factors associated with the time to onset of a new primary cancer. Results: In total, 13,887 patients were included which comprised of 2982 (21%) SOT/HSCT, 7542 (54%) PID/SID and 3363 (24%) patients receiving TNF-i. The mean (SD) age ranged from 46.8 (15) years - 50.4 (18.2) years. The proportion of white patients ranged from 72.3–84.8%. The estimated cumulative cancer incidence was 11.5% in the SOT/HSCT cohort, 14.3% in the PID/SID cohort, and 8.8% in the TNF-i cohort. The multivariable model adjusted for age, benign in-situ disease, Charlson Comorbidity Index, hypertension/cardiovascular disease/end stage renal disease, gender, race/ethnicity, and renal cyst as significant risk factors. The adjusted hazard ratios for cancer development in SOT/HSCT and PID/SID cohorts compared to the TNF-i cohort over the full follow-up period were 1.57 (95% CI: 1.16–2.13) and 2.14 (95% CI: 1.65–2.77), respectively. Conclusion: A significantly increased risk of cancer was observed in PID/SID patients and SOT/HSCT patients compared to TNF-i patients. Age ≥ 50 years, male gender, and clinical comorbidities were additional factors impacting cancer risk. PID/SID and SOT/HSCT patients may benefit from more intensive cancer screening.

Original languageEnglish (US)
Article number33
JournalBMC Cancer
Issue number1
StatePublished - Dec 2023

Bibliographical note

Funding Information:
Sabrina Ilham, Connor Willis, Kibum Kim, Malinda S. Tan, Chia Jie Tan, Diana I. Brixner, David D. Stenehjem received research funding from GRAIL, LLC. to conduct this study. Karen C. Chung and Brenda M. Wood are employees of GRAIL, LLC.

Funding Information:
This study was funded by GRAIL, LLC., a subsidiary of Illumina Inc., currently held separate from Illumina Inc. under the terms of the Interim Measures Order of the European Commission dated 29 October 2021. The sponsor contributed to study conception and design, protocol review, data interpretation and review of final study report, abstract, poster and manuscript.

Publisher Copyright:
© 2023, The Author(s).


  • Cancer incidence
  • Immunocompromised
  • Primary/secondary immunodeficiency
  • TNF-i
  • Transplant

PubMed: MeSH publication types

  • Journal Article


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