title: Risk for secondary thyroid carcinoma after hematopoietic stem-cell transplantation: an EBMT Late Effects Working Party Study.
abstract: OBJECTIVE
  The effects of hematopoietic stem-cell transplantation (HSCT) on thyroid carcinogenesis needs to be determined in a large population. This study evaluates the incidence and the risk factors contributing to secondary thyroid carcinoma (STC) in patients who receive transplantation.
  
  
  METHODS
  We performed a retrospective investigational study, comparing data obtained by means of a two-step questionnaire from the 166 centers who replied, and data reported to the European Group for Blood and Marrow Transplantation (EBMT) registry on their transplantation activity. During the follow-up period (1985 to 2003), 32 instances of STC were found within the EBMT cohort of 68,936 patients who received transplants. These patients were then compared with age- and sex-specific incidence rates in the European population and risk factors for STC were analyzed.
  
  
  RESULTS
  The standardized incidence ratios (SIRs) of STC in the population who underwent transplantation was 3.26, in comparison with the European population. Multivariate analysis revealed that young age at transplantation was the strongest risk factor for STC (relative risk [RR], 24.61 for age 0 to 10 years; RR, 4.80 for age 11 to 20). Other risk factors were irradiation (RR, 3.44), female sex (RR, 2.79), and chronic graft-versus-host disease (RR, 2.94). Nine patients showed no clinical signs of thyroid illness at diagnosis. Total thyroidectomy and iodine ablation was the standard treatment for the majority of patients, and only one patient died due to STC progression.
  
  
  CONCLUSIONS
  Long-term survivors of HSCT are at risk for STCs. These results should promote efforts in screening for early detection and treatment guidelines of secondary thyroid cancer after HSCT, especially in patients who receive transplants during childhood and adolescence.
authors.affiliation: Department of Pediatrics, University of Genova, Polo del Ponente, San Paolo Hospital, Savona, Italy. a.cohen@asl2.liguria.it
authors.forename: Amnon
authors.initials: A
authors.lastname: Cohen
authors.forename: Attilio
authors.initials: A
authors.lastname: Rovelli
authors.forename: Domenico Franco
authors.initials: DF
authors.lastname: Merlo
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: van Lint
authors.forename: Edoardo
authors.initials: E
authors.lastname: Lanino
authors.forename: Dorine
authors.initials: D
authors.lastname: Bresters
authors.forename: Marcello
authors.initials: M
authors.lastname: Ceppi
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bocchini
authors.forename: André
authors.initials: A
authors.lastname: Tichelli
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D006402:Hematologic Diseases / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000209:etiology*; D019172:Transplantation Conditioning / Q000379:methods