title: Second solid cancers after allogeneic hematopoietic cell transplantation using reduced-intensity conditioning.
abstract: We examined risk of second solid cancers after allogeneic hematopoietic cell transplantation (AHCT) using reduced-intensity/nonmyeloablative conditioning (RIC/NMC). RIC/NMC recipients with leukemia/myelodysplastic syndrome (MDS) (n = 2833) and lymphoma (n = 1436) between 1995 and 2006 were included. In addition, RIC/NMC recipients 40 to 60 years of age (n = 2138) were compared with patients of the same age receiving myeloablative conditioning (MAC, n = 6428). The cumulative incidence of solid cancers was 3.35% at 10 years. There was no increase in overall cancer risk compared with the general population (leukemia/MDS: standardized incidence ratio [SIR] .99, P = 1.00; lymphoma: SIR .92, P = .75). However, risks were significantly increased in leukemia/MDS patients for cancers of lip (SIR 14.28), tonsil (SIR 8.66), oropharynx (SIR 46.70), bone (SIR 23.53), soft tissue (SIR 12.92), and vulva (SIR 18.55) and skin melanoma (SIR 3.04). Lymphoma patients had significantly higher risks of oropharyngeal cancer (SIR 67.35) and skin melanoma (SIR 3.52). Among RIC/NMC recipients, age >50 years was the only independent risk factor for solid cancers (hazard ratio [HR] 3.02, P < .001). Among patients ages 40 to 60 years, when adjusted for other factors, there was no difference in cancer risks between RIC/NMC and MAC in leukemia/MDS patients (HR .98, P = .905). In lymphoma patients, risks were lower after RIC/NMC (HR .51, P = .047). In conclusion, the overall risks of second solid cancers in RIC/NMC recipients are similar to the general population, although there is an increased risk of cancer at some sites. Studies with longer follow-up are needed to realize the complete risks of solid cancers after RIC/NMC AHCT.
authors.affiliation: Center for Allogeneic Stem Cell Transplantation, Karolinka University Hospital, Stockholm, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Ruta
authors.initials: R
authors.lastname: Brazauskas
authors.affiliation: Center for International Bone and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Pediatric Hematology & Oncology, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, California.
authors.forename: David
authors.initials: D
authors.lastname: Buchbinder
authors.affiliation: Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Burns
authors.affiliation: Clinique Universitaire d'Hématologie, University Hospital, Grenoble, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.affiliation: Pediatric Stem Cell Transplantation Program, Dana Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Christine
authors.initials: C
authors.lastname: Duncan
authors.affiliation: Department of Hematology Oncology, All Children's Hospital, St. Petersburg, Florida.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.affiliation: Department of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Joerg
authors.initials: J
authors.lastname: Halter
authors.affiliation: Division of Pediatric Hematology/Oncology, Washington University, St. Louis Children's Hospital, St. Louis, Missouri.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hayashi
authors.affiliation: Division of Hematology & Oncology, Shands HealthCare, University of Florida, Gainesville, Florida.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Hsu
authors.affiliation: Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC.
authors.forename: David A
authors.initials: DA
authors.lastname: Jacobsohn
authors.affiliation: Center for Gene Therapy, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas.
authors.forename: Rammurti T
authors.initials: RT
authors.lastname: Kamble
authors.affiliation: AABB Center for Cellular Therapies, Bethesda, Maryland.
authors.forename: Naynesh R
authors.initials: NR
authors.lastname: Kamani
authors.affiliation: Pediatric Bone Marrow Transplantation Program, University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kasow
authors.affiliation: Department of Hematology/Oncology, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.affiliation: Division of Hematology and Oncology, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Alison W
authors.initials: AW
authors.lastname: Loren
authors.affiliation: Adult BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom.
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Kasiani C
authors.initials: KC
authors.lastname: Myers
authors.affiliation: Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Muthalagu
authors.initials: M
authors.lastname: Ramanathan
authors.affiliation: Center for International Bone and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
authors.affiliation: Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Department of Medicine and Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands.
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.affiliation: Service d'Hematologie-Greffe de Moelle, Hopital Saint Louis, Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Socie
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, and Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Mohamed L
authors.initials: ML
authors.lastname: Sorror
authors.affiliation: Department of Hematology and Medical Oncology, Mount Sinai Medical Center, Los Angeles, California.
authors.forename: Amir
authors.initials: A
authors.lastname: Steinberg
authors.affiliation: Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.affiliation: Division of Hematology & Oncology, Shands HealthCare, University of Florida, Gainesville, Florida.
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.affiliation: Center for Allogeneic Stem Cell Transplantation, Karolinka University Hospital, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Mattsson
authors.affiliation: Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio. Electronic address: majhain@ccf.org.
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology*; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods*; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: Hematopoietic cell transplantation; Nonmyeloablative conditioning; Reduced-intensity conditioning; Second cancers; Solid tumors