Incident cancers and late mortality in Australian children treated by allogeneic stem cell transplantation for non-malignant diseases.
Hematopoietic stem cell transplantation (HSCT) is a life-saving procedure for children with a variety of non-malignant conditions. However, these children face an increased risk of late death and incident cancers after HSCT, which may occur many years after their initial HSCT.



We examined cancer occurrence and late mortality in a population-based cohort of 318 Australian children who underwent allogeneic HSCT for non-malignant disease. Standardized incident ratios (SIRs) and standardized mortality ratios (SMRs) were calculated and compared with population controls.



We identified six (1.9%) cancers at a median 9.2 years post-HSCT. Cancer occurred 15 times more frequently than in the general population (SIR 15.4, 95% CI = 6.9-34.2). Of the 198 patients who survived for at least 2 years post-HSCT, 11 (5.6%) died at a median 7.5 years post-HSCT. The mortality rate was 17 times higher than in the general population (SMR 17.5, 95% CI = 9.7-31.2).



Children transplanted for non-malignant conditions require evidence-based survivorship programs to reduce excess morbidity and mortality.
Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.|School of Women's & Children's Health, Faculty of Medicine, UNSW, Randwick, Australia.
Adam S
AS
Nelson
Prince of Wales Clinical School, Lowy Cancer Research Centre, University of New South Wales, Randwick, Australia.
Claire M
CM
Vajdic
Research Portfolio, The University of Sydney, Sydney, Australia.
Lesley J
LJ
Ashton
Children's Cancer Institute Australia for Medical Research, Lowy Cancer Centre, University of New South Wales, Randwick, Australia.
Renate E
RE
Le Marsney
Australasian Bone Marrow Transplant Recipient Registry, Darlinghurst, Australia.
Ian
I
Nivison-Smith
Australasian Bone Marrow Transplant Recipient Registry, Darlinghurst, Australia.
Leonie
L
Wilcox
Department of Haematology and Stem Cell Transplantation, St. Vincents Hospital, Darlinghurst, Australia.
Anthony J
AJ
Dodds
Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.|School of Women's & Children's Health, Faculty of Medicine, UNSW, Randwick, Australia.
Tracey A
TA
O'Brien
D000293:Adolescent; D000741:Anemia, Aplastic / Q000150:complications / Q000628:therapy*; D001315:Australia / Q000453:epidemiology; D001855:Bone Marrow Diseases / Q000150:complications / Q000628:therapy*; D000080983:Bone Marrow Failure Disorders; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006457:Hemoglobinuria, Paroxysmal / Q000150:complications / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008661:Metabolism, Inborn Errors / Q000150:complications / Q000628:therapy*; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D053632:X-Linked Combined Immunodeficiency Diseases / Q000150:complications / Q000628:therapy*
allogeneic stem cell transplantation; cancer incidence; children; late mortality; non-malignant; risk