Solid cancers after allogeneic hematopoietic cell transplantation.
Transplant recipients have been reported to have an increased risk of solid cancers but most studies are small and have limited ability to evaluate the interaction of host, disease, and treatment-related factors. In the largest study to date to evaluate risk factors for solid cancers, we studied a multi-institutional cohort of 28 874 allogeneic transplant recipients with 189 solid malignancies. Overall, patients developed new solid cancers at twice the rate expected based on general population rates (observed-to-expected ratio 2.1; 95% confidence interval 1.8-2.5), with the risk increasing over time (P trend < .001); the risk reached 3-fold among patients followed for 15 years or more after transplantation. New findings showed that the risk of developing a non-squamous cell carcinoma (non-SCC) following conditioning radiation was highly dependent on age at exposure. Among patients irradiated at ages under 30 years, the relative risk of non-SCC was 9 times that of nonirradiated patients, while the comparable risk for older patients was 1.1 (P interaction < .01). Chronic graft-versus-host disease and male sex were the main determinants for risk of SCC. These data indicate that allogeneic transplant survivors, particularly those irradiated at young ages, face increased risks of solid cancers, supporting strategies to promote lifelong surveillance among these patients.
Rizzo
J Douglas
JD
Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA. izzo@mcw.edu
Curtis
Rochelle E
RE
Socié
Gérard
G
Sobocinski
Kathleen A
KA
Gilbert
Ethel
E
Landgren
Ola
O
Travis
Lois B
LB
Travis
William D
WD
Flowers
Mary E D
ME
Friedman
Debra L
DL
Horowitz
Mary M
MM
Wingard
John R
JR
Deeg
H Joachim
HJ
D000367:Age Factors; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation