Challenges in managing chronic kidney disease with simultaneous renal transplant immunosuppressant induced buccal squamous cell carcinoma and gastric Burkitt's like lymphoma: A case report

Abstract

Immunodeficiency is associated with higher cancer incidence, especially in transplanted patients; however, it is unknown whether there is a link between immunodeficiency and the development of multiple primary malignancies. Immunosuppressive drugs may either indirectly potentiate the effect of carcinogens or directly damage the DNA. Skin cancers are the most common malignancies diagnosed in renal transplant recipients. Management of immunosuppression in recipients of transplants who are living with cancer is complex and challenging. A concerted approach between transplant professionals, oncologists, and allied health professionals is therefore needed to ensure optimal care for transplant recipients who are developing immunodeficiency-induced malignancies. Here, we report a challenging case that presented with two simultaneous malignancies (buccal squamous cell carcinoma and gastric Burkitt's-like lymphoma) after nine years of being on immunosuppressants after the kidney transplant. The patient tolerated his cancer treatments with some grade II-III toxicities and is currently a two-year disease-free survivor. Focusing on the curative intent approaches for the two cancers with the adjustment of the immunosuppressant medications, besides the complications associated with these radical treatments, is worthy of being presented to the transplant and oncology teams globally.

Keywords

• Immunodeficiency
• Multiple cancer primaries, Immunosuppressant-induced malignancies
• Buccal cancer
• Gastric Burkitt-like lymphoma