title: Long-term follow-up of secondary malignancies in adults after allogeneic bone marrow transplantation.
abstract: The purpose of this study was to evaluate the estimated incidence of secondary malignancies post-allogeneic bone marrow transplantation (BMT) in a cohort of adult patients previously reported now with an additional 8.5 years of follow-up. A cohort of 557 patients older than age 16 years underwent allogeneic BMT between June 1970 and November 1993. Histologic reports confirmed the diagnosis of a secondary malignancy. Multivariate Cox proportional hazards method was utilized to investigate predictors for the development of secondary malignancies. In all, 31 patients in this cohort developed a secondary malignancy a median of 6.79 years after their transplant. The estimated cumulative incidence rate of secondary malignancy was 4.2% at 10 years post transplant. When compared to the general population, the estimated observed/expected ratio of new cancer diagnoses was 5.13. On multivariate analysis, older age at the time of transplant was the only significant predictor for development of secondary cancer (P=0.01). The most common malignancies observed were nonmelanomatous skin cancers and squamous cell cancers of the buccal cavity. The risk of developing a secondary malignancy after allogeneic BMT is significant, particularly in older patients. Long-term survivors of transplant require regular monitoring for early signs of cancer, particularly of the skin and oral cavity.
authors.affiliation: Allogeneic Bone Marrow Transplant Service, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada M5G 2M9.
authors.forename: W
authors.initials: W
authors.lastname: Hasegawa
authors.forename: G R
authors.initials: GR
authors.lastname: Pond
authors.forename: J T
authors.initials: JT
authors.lastname: Rifkind
authors.forename: H A
authors.initials: HA
authors.lastname: Messner
authors.forename: A
authors.initials: A
authors.lastname: Lau
authors.forename: A S
authors.initials: AS
authors.lastname: Daly
authors.forename: T L
authors.initials: TL
authors.lastname: Kiss
authors.forename: N
authors.initials: N
authors.lastname: Kotchetkova
authors.forename: A
authors.initials: A
authors.lastname: Galal
authors.forename: J H
authors.initials: JH
authors.lastname: Lipton
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000556:secondary; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease; D019337:Hematologic Neoplasms / Q000628:therapy*; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000556:secondary; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary; D016016:Proportional Hazards Models; D012008:Recurrence; D012306:Risk; D012878:Skin Neoplasms / Q000556:secondary; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000009:adverse effects*