Skin cancer after nonmyeloablative hematopoietic cell transplantation

Cavalier, Marie; Shmalo, James A.; Yu, Menggang; Billings, Steven D.; Abonour, Rafat; Nelson, Ronelson P.

doi:10.1038/sj.bmt.1705362

Cited by 19 publications

(16 citation statements)

References 48 publications

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“…It is likely that hospitalization and the prevailing recommendations to avoid sun exposure to prevent triggering of GvHD partly explain the decline in vitamin D levels following transplantation observed in this study. Given the increased risk of skin cancer associated with HSCT and sun exposure, 31 we would hesitate to recommend increased sunbathing for transplanted patients. An alternative is oral supplementation before or during immune reconstitution.…”

Section: Discussionmentioning

confidence: 99%

Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation

Bahr

Blennow

Alm

et al. 2015

Bone Marrow Transplant

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Vitamin D has emerged as a central player in the immune system, with its deficiency being implicated in the pathogenesis of several autoimmune diseases, including chronic GvHD. This is a retrospective cohort analysis of 166 patients, who underwent allogeneic hematopoietic stem cell transplantation (HSCT) at the Karolinska University Hospital, evaluating GvHD, graft failure, infectious complications and survival after HSCT in relation to pre-transplantation vitamin D levels. Most of the patients were deficient in vitamin D before HSCT (median 42 nmol/L). In multivariate analysis, vitamin D level before HSCT was identified as a significant independent risk factor for development of cGvHD. The increased incidence of cGvHD was not coupled to better disease-free survival; instead there was a trend towards lower overall survival in the vitamin D-deficient patients. In addition, we found a significant correlation between vitamin D deficiency and incidence of CMV disease, with no case of CMV disease occurring in patients with sufficient levels of vitamin D before HSCT. Our results support a role of vitamin D in immune tolerance following HSCT. These findings could be highly relevant for the care of HSCT patients, and prospective, randomized studies on the effect of vitamin D supplementation are therefore needed.

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Section: Discussionmentioning

confidence: 99%

Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation

Bahr

Blennow

Alm

et al. 2015

Bone Marrow Transplant

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“…A recent case report of skin cancers following nonmyeloablative HCT suggests that the risk of second malignancies persists in this group of patients. 43 Future studies should evaluate contributions to the risk of second malignancies among transplant conditioning regimens that do not include radiation, and where peripheral blood is the source of hematopoietic stem cells.…”

Section: Discussionmentioning

confidence: 99%

Solid cancers after allogeneic hematopoietic cell transplantation

Rizzo

Curtis

Socié

et al. 2009

Blood

445

473

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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. (Blood. 2009; 113:1175-1183)

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“…The likelihood of BCC and SCC increases when a patient is immunocompromised, [68][69][70][71][72][73][74][75][76][77][78][79][80][81] such as after an organ transplant and during or after long-term PUVA. Usually, the incidence of SCC is higher than that of BCC in immunosuppressed patients.…”

Section: Immunosuppressionmentioning

confidence: 99%