Gastrointestinal tumors in transplantation: Two case reports and review of literature

Table 1 Characteristics of 16 transplanted patients with gastrointestinal stromal tumors

	Overall number
Male sex, n (%)	16	11 (69)
Age (yr), median (min; max)	16	59.5 (23; 74)
Type of organ transplantation, n (%)	16
Kidney		12 (75)
Liver		4 (25)
Location of primitive tumor, n (%)	16
Stomach		9 (56)
Small bowel		3 (19)
Colon		1 (6)
Other: pelvis, perineum, mesentery		3 (19)
Time from transplantation to diagnosis (mo), median (min; max)	16	32 (5; 252)
Metastatic dissemination at diagnosis, n (%)	16	0 (0)
Tumor size (mm), median (min; max)	15	45 (10; 230)
Risk of progression according to Joensuu’s criteria, n (%)	14
Very low		2 (14)
Low		4 (29)
Intermediate		2 (14)
High		6 (43)
Surgical treatment, n (%)	16	15 (94)
Adjuvant treatment, n (%)	16	3 (19)
Modification of immunosuppression, n (%)	11	9 (82)
Death during follow-up, n (%)	14	4 (29)

Table 2 Clinical features and immunosuppression regimen of 16 transplant patients with gastrointestinal stromal tumor

Ref.	Age (yr)/sex	Transplanted organ	Time from transplantation to diagnosis	Location of primitive GIST	Metastasis at diagnosis		Evolution/delay	Immunosuppression before diagnosis	Immunosuppression after diagnosis
Agaimy and Wünsch[11]	59/F	Kidney	40 mo	Stomach	No	Relapse 68 mo		Not described	Not described
Agaimy and Wünsch[11]	58/F	Kidney	96 mo	Small bowel	No	Not described		Not described	Not described
Saidi et al[19]	54/M	Liver	11 mo	Colon	No	Not described		Tac, Aza	Not described
Camargo et al[22]	64/M	Liver	7 mo	Perineum	No	Not described		Tac, mycophenolate sodium	Not described
Tu et al[18]	57/F	Kidney	6 mo	Pelvis	No	Not described		Steroids, CsA, MMF	CsA and MMF at half dosage; rapamycin-containing regimensteroids withdrawn
Mulder et al[12]	72/M	Kidney	21 yr	Stomach	No	Peritoneal metastasis/24 mo		Steroids, CsA	Steroids, CsA (60% reduction in dosage)
Mrzljak et al[20]	53/M	Liver	12 mo	Jejunum	No	No		Tac, MMF	Same
Cimen et al[13]	46/F	Kidney	18 yr	Stomach	No	Not described		Steroids, CsA, Aza	Same with reduced dosage of CsA
Cheung et al[14]	64/M	Kidney	2 yr	Stomach	No	Yes/2 yr		Steroids, Tac, MMF	Steroids, Tac (reduced dosage), everolimus
Cheung et al[14]	48/M	Kidney	1 yr	Mesentery	Multiple tumors	No		CsA, MMF	CsA withdrawal, sirolimus introduction
Patiño et al[15]	23/F	Kidney	13 yr	Stomach	No	Local relapse/3 yr		Steroids, Tac, MMF	Not described
Xie et al[21]	60/M	Liver	11 mo	Stomach	No	No		Tac, sirolimus, MMF	Same
Elkabets et al[17]	74/M	Kidney	7 yr	Stomach	No	No		Steroids, CsA, MMF	Switch CsA to mTOR inhibitor
Takahashi et al[16]	64/M	Kidney	72 mo	Small bowel	No	No		Steroids, CsA, MMF	Stop CsA
Stammler et al	60/M	Kidney	5 mo	Stomach	No	No		Steroids, Tac, MMF	Switch MMF to belatacept
Stammler et al	64/M	Kidney	51 mo	Stomach	No	Yes/23 mo		Steroids, CsA, MMF	Switch CsA to Tac

Aza: Azathioprine; CsA: Cyclosporine; F: Female; GIST: Gastrointestinal stromal tumor; M: Male; MMF: Mycophenolate mofetil; mTOR: Mammalian target of rapamycin; Tac: Tacrolimus.

Table 3 Histopathological features, treatments, and outcome of 16 transplant patients with gastrointestinal stromal tumor

Ref.	Size (mm)	Mitotic count	Fletcher’s criteria	Joensuu’s criteria	Mutation identified	Resection	Initial adjuvant treatment	Second line treatment	Outcome
Agaimy and Wünsch[11]	35	< 5/50	Low	Low	Not described	Yes	No	Not described	Alive and relapse free at 68 mo
Agaimy and Wünsch[11]	230	14/50	High	High	Not described	Yes	No	Not described	Not described
Saidi et al[19]	25	1/50	Low	High	Not described	Yes	No	Not described	Alive and relapse free at 18 mo
Camargo et al[22]	50	5/50	Intermediate	High	Not described	Yes	No	Not described	Alive and relapse free at 20 mo
Tu et al[18]	45	2-3/50	Low	Low	PDGFRA exon 18 V824V	Yes	No	Not described	Alive and relapse free 24 mo
Mulder et al[12]	50	> 10/50	High	High	Not described	Yes	No	Imatinib 400 mg/d then 200 mg/d	Died 44 mo
Mrzljak et al[20]	10	1/50	Very low	Very low	Not described	Yes	No	No	Died 3 yr after from acute leukemia
Cimen et al[13]	150	14/50	High	High	KIT T574del	Yes	Imatinib 400 mg/d	Not described	Alive and relapse free at 12 mo
Cheung et al[14]	30	9/50	Intermediate	Intermediate	Not described	Yes	No	No	Died from pneumonia at 2 yr
Cheung et al[14]	Not described	Not described	Not described	Not described	Not described	No	Imatinib 400 mg/d for 1 yr	Switch CsA to sirolimus	Alive and relapse free at 10 yr
Patiño et al[15]	58	Not described	Intermediate or high	Intermediate of high	Not described	Yes	No	Imatinib 400 mg/d	Alive and relapse free/5 yr after imatinib initiation
Xie et al[21]	10	< 5/50	Very low	Very low	KIT exon 11	Yes	No	No	Not described
Elkabets et al[17]	31	Not described	Not described	Not described	Not described	Yes	No	No	Alive and relapse free at 40 mo
Takahashi et al[16]	110	20/50	High	High	KIT exon 11	Yes	Imatinib 400 mg/d reduced to 3000 mg/d	No	Alive and relapse free at 18 mo
Stammler et al	27	2/5	Low	Low	KIT exon 11	Yes	No	No	Alive and relapse free at 2 mo
Stammler et al	51	10/50	High	High	PDGFRA exon 18	Yes	No	Sunitinib then regorafenib then dasatinib	Died 56 mo later

CsA: Cyclosporine.