Second Solid Cancers after Allogeneic Hematopoietic Cell Transplantation Using Reduced-Intensity Conditioning |
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| Affiliation: | 1. Center for Allogeneic Stem Cell Transplantation, Karolinka University Hospital, Stockholm, Sweden;2. Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin;3. Center for International Bone and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin;4. Department of Pediatric Hematology & Oncology, University of New Mexico, Albuquerque, New Mexico;5. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya University Graduate School of Medicine, Nagoya, Japan;6. Division of Pediatric Hematology, Children''s Hospital of Orange County, Orange, California;7. Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota;8. Clinique Universitaire d''Hématologie, University Hospital, Grenoble, France;9. Pediatric Stem Cell Transplantation Program, Dana Farber Cancer Institute, Boston, Massachusetts;10. Department of Hematology Oncology, All Children''s Hospital, St. Petersburg, Florida;11. Department of Hematology, University Hospital Basel, Basel, Switzerland;12. Division of Pediatric Hematology/Oncology, Washington University, St. Louis Children''s Hospital, St. Louis, Missouri;13. Division of Hematology & Oncology, Shands HealthCare, University of Florida, Gainesville, Florida;14. Division of Blood and Marrow Transplantation, Children''s National Medical Center, Washington, DC;15. Center for Gene Therapy, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas;16. AABB Center for Cellular Therapies, Bethesda, Maryland;17. Pediatric Bone Marrow Transplantation Program, University of North Carolina Hospitals, Chapel Hill, North Carolina;18. Department of Hematology/Oncology, Mayo Clinic Arizona, Phoenix, Arizona;19. Division of Hematology and Oncology, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio;20. Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;21. Adult BMT Unit, Bristol Children''s Hospital, Bristol, United Kingdom;22. Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;23. Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts;24. Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee;25. Department of Medicine and Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands;26. Service d''Hematologie-Greffe de Moelle, Hopital Saint Louis, Paris, France;27. Clinical Research Division, Fred Hutchinson Cancer Research Center, and Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington;28. Department of Hematology and Medical Oncology, Mount Sinai Medical Center, Los Angeles, California;29. Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas;30. Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio |
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| 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. |
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| Keywords: | Hematopoietic cell transplantation Reduced-intensity conditioning Nonmyeloablative conditioning Second cancers Solid tumors |
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