Long-term follow-up of secondary malignancies in adults after allogeneic bone marrow transplantation

Abstract

Summary:The purpose of this study was to evaluate the estimated incidence of secondary malignancies post-allogeneic bone marrow transplantation (BMT) in a cohort of adult patients previously reported now with an additional 8.5 years of follow-up. A cohort of 557 patients older than age 16 years underwent allogeneic BMT between June 1970 and November 1993. Histologic reports confirmed the diagnosis of a secondary malignancy. Multivariate Cox proportional hazards method was utilized to investigate predictors for the development of secondary malignancies. In all, 31 patients in this cohort developed a secondary malignancy a median of 6.79 years after their transplant. The estimated cumulative incidence rate of secondary malignancy was 4.2% at 10 years post transplant. When compared to the general population, the estimated observed/expected ratio of new cancer diagnoses was 5.13. On multivariate analysis, older age at the time of transplant was the only significant predictor for development of secondary cancer (P ¼ 0.01). The most common malignancies observed were nonmelanomatous skin cancers and squamous cell cancers of the buccal cavity. The risk of developing a secondary malignancy after allogeneic BMT is significant, particularly in older patients. Long-term survivors of transplant require regular monitoring for early signs of cancer, particularly of the skin and oral cavity. Bone Marrow Transplantation (2005) 35, 51-55.

Long-term outcome after allo-SCT: close follow-up on a large cohort treated with myeloablative regimens

“…12,13 Some of the studies addressed specific diseases 10,17,18 others addressed specific complications. 11,13,17,19 In contrast, our study is based on large single institution experience with a consistent approach, including only allo-HSCT patients with different primary diagnoses who have extended 'in-house' follow-up allowing for detection of late death and complications. As with any retrospective study, this study has known weaknesses, including potential bias in capturing patients' complications.…”

“…11,19,[20][21][22][23][24] Radiation and chemotherapy used for treatment of primary disease and in conditioning regimens, as well as profound immunosuppression post allo-HSCT have been identified as contributing factors. 19,20 In our cohort (429 patients), the CI rate of secondary malignancy was 4.3% at 17.6 years with a median time of 6.8 years post allo-HSCT (Figure 2).…”

“…11,19,[20][21][22][23][24] Radiation and chemotherapy used for treatment of primary disease and in conditioning regimens, as well as profound immunosuppression post allo-HSCT have been identified as contributing factors. 19,20 In our cohort (429 patients), the CI rate of secondary malignancy was 4.3% at 17.6 years with a median time of 6.8 years post allo-HSCT (Figure 2). In our univariate and multivariate analyses, age group (o40 vs X40), conditioning regimen (TBI-based vs non-TBI-based), transplant type (related vs unrelated), primary diagnosis or chronic GVHD did not seem to play a role in increasing the risk for secondary malignancy in long-term survivors (Table 3).…”

Association of squamous cell carcinoma of the oral cavity in allogeneic hematopoietic stem cell transplant recipients

“…An important long-term complication following allo-HSCT has been secondary malignancies. 1 We report a case series of allo-HSCT patients developing oral cancers after cure of their primary disease. We hypothesize that secondary oral-cavity squamous cell carcinomas can occur without oral chronic GvHD (cGvHD).…”

“…The peak incidence occurs at 7 years following allo-HSCT. 1 In a recent review, almost all patients who developed oral squamous cell carcinoma had evidence of cGvHD. Interestingly, in our patient series, contrasting with prior reports and earlier hypotheses, oral squamous cell carcinomas developed in two patients without evidence of cGvHD.…”