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Hellström, Vivan
Publications (10 of 11) Show all publications
Hellström, V., Tufveson, G., Wallgren, A., Loskog, A., Larsson, E., Tötterman, T., . . . Lorant, T. (2017). Donor Derived and BK Virus Positive Urologic Cancers After Renal Transplantation. Paper presented at American Transplant Congress, APR 29-MAY 03, 2017, Chicago, IL. American Journal of Transplantation, 17(S3), 472-472, Article ID A188.
Open this publication in new window or tab >>Donor Derived and BK Virus Positive Urologic Cancers After Renal Transplantation
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2017 (English)In: American Journal of Transplantation, ISSN 1600-6135, E-ISSN 1600-6143, Vol. 17, no S3, p. 472-472, article id A188Article in journal, Meeting abstract (Other academic) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-335823 (URN)10.1111/ajt.14306 (DOI)000404515703188 ()
Conference
American Transplant Congress, APR 29-MAY 03, 2017, Chicago, IL
Available from: 2018-01-15 Created: 2018-01-15 Last updated: 2018-01-15Bibliographically approved
Hellström, V., Lorant, T., Döhler, B., Tufveson, G. & Enblad, G. (2017). High posttransplant cancer incidence in renal transplanted patients with pretransplant cancer. Transplantation, 101(6), 1295-1302
Open this publication in new window or tab >>High posttransplant cancer incidence in renal transplanted patients with pretransplant cancer
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2017 (English)In: Transplantation, ISSN 0041-1337, E-ISSN 1534-6080, Vol. 101, no 6, p. 1295-1302Article in journal (Refereed) Published
Abstract [en]

Background. Patients with previous cancer have increasingly been accepted for renal transplantation. Posttransplant cancer risk and survival rates of these patients are unknown. Our objective was to assess the risk of posttransplant cancer in this patient group. Methods. In this retrospective, nested case-control study, we assessed the outcome of all (n = 95) renal transplanted patients with pretransplant cancer diagnoses in the Uppsala-Orebro region, Sweden. The control group was obtained from the Collaborative Transplant Study registry and included European patients without pretransplant cancer. The other control group comprised the entire renal transplanted population in Uppsala. Development of recurrent cancer, de novo cancer, and patient survival were determined. Results. Patients with pretransplant cancer showed higher incidence of posttransplant cancers and shorter survival compared with the control groups (P < 0.001). No obvious pattern in malignant diagnoses was observed. Death-censored graft survival was unaffected. Conclusions. Despite previously adequate cancer treatments and favorable prognoses, almost half of the patients experienced a posttransplant cancer. These observations do not justify abstaining from transplanting all patients with previous malignancies, because more than 50% of the patients survive 10 years posttransplantation. A careful oncological surveillance pretransplant as well as posttransplant is recommended.

National Category
Medical and Health Sciences
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-282111 (URN)10.1097/TP.0000000000001225 (DOI)000401835800026 ()27163539 (PubMedID)
Available from: 2016-04-02 Created: 2016-04-01 Last updated: 2017-07-04Bibliographically approved
Hellström, V., Enström, Y., Enblad, G., Tufveson, G., Renlund, H., Lorant, T. & Nyberg, F. (2017). Risk Factors for De Novo Squamous Cell Carcinoma Development in Renal Transplant Recipients with a Previous Squamous Cell Carcinoma.. Acta Dermato-Venereologica, 97(6), 751-753
Open this publication in new window or tab >>Risk Factors for De Novo Squamous Cell Carcinoma Development in Renal Transplant Recipients with a Previous Squamous Cell Carcinoma.
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2017 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 97, no 6, p. 751-753Article in journal, Editorial material (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-333244 (URN)10.2340/00015555-2606 (DOI)000405575100018 ()28093599 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-02-16Bibliographically approved
Hellström, V., Enström, Y., von Zur-Mühlen, B., Hagberg, H., Laurell, A., Nyberg, F., . . . Lorant, T. (2016). Malignancies in transplanted patients: Multidisciplinary evaluation and switch to mTOR inhibitors after kidney transplantation - experiences from a prospective, clinical, observational study. Acta Oncologica, 55(6), 774-781
Open this publication in new window or tab >>Malignancies in transplanted patients: Multidisciplinary evaluation and switch to mTOR inhibitors after kidney transplantation - experiences from a prospective, clinical, observational study
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2016 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, no 6, p. 774-781Article in journal (Refereed) Published
Abstract [en]

Background Solid organ transplant recipients are at increased risk of developing malignancies. The objective of this prospective, observational, one-armed study was to study the feasibility to add a mammalian target of rapamycin (mTOR) inhibitor to the immunosuppressive regimen in transplanted patients with post-transplant malignancies. During the trial the need to improve identification of post-transplant malignancies and to reassure adequate oncological treatment of these patients became evident. Multidisciplinary team (MDT) evaluation of oncological and immunosuppressive treatments was implemented for all patients with malignancies after renal or combined renal and pancreas transplantation because of the trial.Material and methods At Uppsala University Hospital, Sweden, a MDT consisting of transplant surgeons, nephrologists, oncologists and dermatologists evaluated 120 renal or combined renal and pancreas-transplanted recipients diagnosed with malignancies from September 2006 to July 2012. To identify all malignancies, the population was linked to the Regional Tumor Registry (RTR). We recorded to which extent a switch to mTOR inhibitors was possible and how often the originally planned oncological managements were adjusted. All patients were followed for three years. (ClinicalTrials.gov: NCT02241564).Results In 76 of 120 patients (63%) a switch to mTOR inhibitors was possible. Immunosuppression was interrupted in seven patients (6%), reduced in three patients (2%) and remained unchanged in 34 of 120 patients (28%). Identification of post-transplant malignancies increased significantly after linkage to RTR (p=0.015). The initially recommended oncological treatment was adjusted in 23 of 44 patients (52%) with solid or hematological malignancies; 36 of these patients (82%) were treated according to national guidelines.Conclusion In two thirds of the patients the immunosuppressive treatment could be changed to an mTOR inhibitor with anti-tumor effects in transplanted patients with post-transplant malignancies. The use of regional tumor registers considerably improved the identification of patients with post-transplant malignancies indicating that post-transplant malignancies might be timely underreported in transplant registers.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016
Keywords
Malignant tumours, Renal transplantation
National Category
Cancer and Oncology
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-282106 (URN)10.3109/0284186X.2015.1130855 (DOI)000377122300017 ()26824275 (PubMedID)
Available from: 2016-04-02 Created: 2016-04-01 Last updated: 2017-11-30Bibliographically approved
Hellström, V. (2016). The clinical perspective on malignancies in renal transplanted patients. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>The clinical perspective on malignancies in renal transplanted patients
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Post-transplant malignancies cause significant morbidity and mortality. In this thesis we investigated malignancies in renal transplanted patients from a clinical viewpoint. The use of regional tumour registries considerably improved identification of pre- and post-transplant malignancies, which are generally underreported in transplant registries.

Despite previously adequate cancer treatments with favourable prognosis, patients with pre-transplant malignancies showed higher incidence of post-transplant cancer and reduced survival compared to a 1:3 ratio matched control group of patients without a previous cancer from the Collaborative Transplant Study in Europe. A careful oncological surveillance pre-transplant and post-transplant is recommended.

A multidisciplinary team evaluated the immunosuppressive and oncological treatment in a clinical prospective observational study of 120 renal transplanted patients with post-transplant malignancies. In two-thirds of the patients immunosuppression was possible to change to mTOR inhibitors with anti-tumour effects. Oncological treatment was adjusted in 50% of patients with solid or haematological tumours. MDT assessments are essential for optimizing treatment of post-transplant malignancies.

Number of previous cutaneous squamous cell carcinoma (SCC) posed the most significant risk variable in predicting subsequent SCCs during a two-years study of 73 transplanted patients with at least one SCC.

Incidence of transplant-derived tumours is 5 times higher than anticipated. Three of eleven cancers in urinary tract and two of four cancers in the transplants were transplant-derived. Five of eleven cancers of the urinary tract were BK-virus positive. Allograft immune response against these tumours offer new options for cancer treatment such as immunomodulatory or anti-viral treatment in combination with modified immunosuppression.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. p. 82
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1210
Keywords
renal transplantation, malignant tumours
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-282131 (URN)978-91-554-9549-7 (ISBN)
Public defence
2016-06-04, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2016-05-13 Created: 2016-04-02 Last updated: 2016-06-01
Hellström, V., Lorant, T., Dohler, B., Tufveson, G. & Enblad, G. (2015). Elevated Post-Transplant Cancer Incidence And Reduced Survival In Patients With Pretransplant Tumors. Transplant International, 28, 183-184
Open this publication in new window or tab >>Elevated Post-Transplant Cancer Incidence And Reduced Survival In Patients With Pretransplant Tumors
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2015 (English)In: Transplant International, ISSN 0934-0874, E-ISSN 1432-2277, Vol. 28, p. 183-184Article in journal, Meeting abstract (Other academic) Published
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-281008 (URN)000367726701156 ()
Available from: 2016-03-16 Created: 2016-03-16 Last updated: 2017-11-30Bibliographically approved
Malm, H., Bäckman, L., Biglarnia, A., Hellström, V., Larsson, E., Lorant, T., . . . Tufveson, G. (2013). The Uppsala Experience of Switching from Cni:s to Belatacept after Kidney Transplantation. Transplant International, 26, 92-93
Open this publication in new window or tab >>The Uppsala Experience of Switching from Cni:s to Belatacept after Kidney Transplantation
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2013 (English)In: Transplant International, ISSN 0934-0874, E-ISSN 1432-2277, Vol. 26, p. 92-93Article in journal, Meeting abstract (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-218525 (URN)000328232000358 ()
Available from: 2014-02-13 Created: 2014-02-12 Last updated: 2017-12-06Bibliographically approved
Hellström, V., Wilczek, H., Roussos, J., Lorant, T., Enblad, G., Nyberg, F. & Tufveson, G. (2012). Njurtransplanterade med maligna tumörer en växande patientgrupp: [Kidney transplanted persons with malignant tumors is a growing patient group]. Läkartidningen, 109(39-40), 1766-1769
Open this publication in new window or tab >>Njurtransplanterade med maligna tumörer en växande patientgrupp: [Kidney transplanted persons with malignant tumors is a growing patient group]
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2012 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 39-40, p. 1766-1769Article in journal (Refereed) Published
Abstract [en]

The incidence of malignant tumors in the organ transplanted population is increased 3-5 fold compared to the general population. The spectrum of tumors is different, the tumor growth is more aggressive and the prognosis is worse. In order to identify patients with post-transplant malignant tumors, the transplant registries in Stockholm, Uppsala and Gothenburg were cross run with the respective regional oncologic registries (ROC). It was found, that despite a generally good follow up, information about more than 50% of the malignant tumors is missing at the transplant centers. According to international guidelines this patient group should be evaluated by multidisciplinary teams consisting of transplant surgeons/nephrologists, oncologists and dermatologists with experience of transplantation to get optimal medical treatment. We would therefore like to emphasize the importance of referring all renal transplanted patients with malignant tumors to the transplant centers for multidisciplinary evaluation of the immunosuppressive as well as oncologic treatment.

National Category
Surgery Cancer and Oncology
Research subject
Surgery; Oncology
Identifiers
urn:nbn:se:uu:diva-189245 (URN)23097887 (PubMedID)
Available from: 2012-12-28 Created: 2012-12-28 Last updated: 2017-12-06Bibliographically approved
Eaker, S., Dickman, P. W., Hellström, V., Zack, M. M., Ahlgren, J. & Holmberg, L. (2005). Regional differences in breast cancer survival despite common guidelines. Cancer Epidemiology, Biomarkers and Prevention, 14(12), 2914-8
Open this publication in new window or tab >>Regional differences in breast cancer survival despite common guidelines
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2005 (English)In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 14, no 12, p. 2914-8Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Despite a uniform regional breast cancer care program, breast cancer survival differs within regions. We therefore examined breast cancer survival in relation to differences in diagnostic activity, tumor characteristics, and treatment in seven Swedish counties within a single health care region. METHODS: We conducted a population-based observational study using a clinical breast cancer register in one Swedish health care region. Eligible women (n = 7,656) ages 40 to 69 years diagnosed with primary breast cancer between 1992 and 2002 were followed up until 2003. The 7-year relative survival ratio was used to estimate breast cancer survival. Excess mortality was modeled using Poisson regression to study differences in survival between counties. RESULTS: The 7-year relative survival for breast cancer patients was significantly lower (up to 7% in absolute risk difference) in one county (county A) compared with the others. This difference existed only among women diagnosed before 1998, ages 50 to 59 years, and was strongest among stage II breast cancer patients. Adjustment for amount of diagnostic activity eliminated the survival differences among the counties. The amount of diagnostic activity was also lower in county A during the same time period. After county A, during 1997-1998, began to adhere strictly to the regional breast cancer care program, neither any survival differences nor diagnostic activity differences were observed. INTERPRETATIONS: Markers of diagnostic activity explained survival differences within our region, and the underlying mechanisms may be several. Low diagnostic activity may entail later diagnosis or inadequate characterization of the tumor and thereby missed treatment opportunities. Strengthening of multidisciplinary management of breast cancer can improve survival.

Keywords
Adult, Aged, Breast Neoplasms/*mortality/*pathology, Female, Humans, Mass Screening, Middle Aged, Neoplasm Staging, Poisson Distribution, Prognosis, Registries, Research Support; Non-U.S. Gov't, Survival Analysis, Sweden/epidemiology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-81289 (URN)16365009 (PubMedID)
Available from: 2007-03-26 Created: 2007-03-26 Last updated: 2017-12-14Bibliographically approved
Hellström, V., Tufveson, G., Wallgren, A. C., Loskog, A., Larsson, E., Töttermann, T., . . . Lorant, T.Donor-derived and BK virus positive urologic cancers after renal transplantation.
Open this publication in new window or tab >>Donor-derived and BK virus positive urologic cancers after renal transplantation
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(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-282126 (URN)
Available from: 2016-04-02 Created: 2016-04-02 Last updated: 2016-06-01
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