Treatment of solid tumors following allogeneic bone marrow transplantation

Abstract

Summary:Second solid tumors are well known late complications after bone marrow transplantation. Treatment strategies are ill defined. We retrospectively evaluated treatment and outcome in a single institution. From August 1974 to July 1996, six solid tumors were observed in five of 387 patients 2 to 13 years after BMT, corresponding to a probability of developing a second solid tumor of 9% (1-17%, 95 CI) at 15 years: these comprised endometrial carcinoma, carcinoma of the thyroid gland, cervical carcinoma, sarcoma of the small intestine, osteosarcoma of the tibia and ovarian carcinoma. All five patients were treated as intensively as they would be without a history of BMT. At last follow-up four of the five patients were alive and without signs of tumor. We postulate that second solid tumors after BMT should be treated as de novo tumors. Early detection based on consequent clinical follow-up of the transplant patients might explain the relatively good outcome. Bone Marrow Transplantation (2000) 25, 895-898. Keywords: bone marrow transplantation; second solid tumor; treatment; outcome Allogeneic hematopoietic stem cell transplantation is the treatment of choice for many hematological disorders of the bone marrow. 1,2 With improvements in the results, the number of long-term survivors increases continuously. Therefore, late complications have become a concern. 3,4 Among these, three types of malignancies have been described: post-transplant lymphoproliferative disorders, secondary leukemias and second solid tumors. Lymphoproliferative diseases are mainly observed early post transplant during immunosuppressive therapy, secondary leukemias occur 3-5 years post transplant and second solid tumors appear mostly 5 or more years post transplant. [5][6][7] The risk of long-term survivors for developing a second tumor at 15 years after transplantation is as high as 21%. plantation. 9,10 In contrast, few data exist about treatment of second solid tumors and prognosis is considered to be poor. Here, we present the outcome of five patients who have been appropriately treated for their second solid tumor. Patients and methods Study designAll consecutive recipients of allogeneic stem cell transplantation, treated between August 1974 and July 1996 in Basel, were included in this retrospective cohort study. All charts were reviewed for evidence of second solid tumors, details of the tumor, treatment and outcome. Patient population and transplant regimensThree hundred and eighty-seven patients were transplanted with a median age at transplantation of 26 years (range 1-58 years); 55% of the patients were male. One hundred and fifteen patients (30%) were treated for acute myeloid leukemia, 88 (23%) for acute lymphocytic leukemia, 91 (24%) for chronic myeloid leukemia, 50 (13%) for severe aplastic anemia and 43 patients (10%) for other hematological diseases. Donors were HLA-identical siblings (91%), matched unrelated (4%), twins (4%) and mismatched related (1%). Median follow-up was 7 years (range 1.5-23).Patient care remained rela...

Secondary malignancies and quality of life after stem cell transplantation

“…Early detection and intensive treatment may favor a good outcome. 21 Conclusion. The incidence of post transplant malignancies is relatively low although estimates of the overall risk require a long follow-up.…”

Osteosarcoma after allogeneic bone marrow transplantation. A report of four cases from the Cooperative Osteosarcoma Study Group (COSS)

“…We 37 and others 38 have recently been able to show that treatment according to the principles used for primary osteosarcoma may lead to long-term disease-free survival in a significant subgroup of affected individuals. The results reported here and in one previously published patient, 7 while hampered by very small numbers and limited follow-up, indicate that this may also be true for osteosarcoma after BMT. They demonstrate that osteosarcoma-directed chemotherapy, adapted to account for previous exposure especially to anthracyclines, can be administered after BMT, albeit not without sometimes substantial side effects.…”

“…Among these, genetic predisposition and cytotoxic chemo-and radiotherapy may be the most important. Three of the four patients reported here and all three other patients reported in the literature [6][7][8] received TBI as part of their conditioning regimen, which has been linked to the development of solid tumors after BMT. 2,6 It is well known that ionizing irradiation can induce the development of malignant bone tumors.…”

“…[2][3][4] Even though individuals who had cancer in childhood may be at a higher risk of developing bone cancer than any other type of second primary cancer 5 and even though the risk of bone and connective tissue tumors may also be slightly increased after HSCT, 2 there have been only scanty reports of secondary osteosarcoma after bone marrow transplantation (BMT). 2,[6][7][8] To our knowledge, a total of no more than three cases have been published to date. Here, we describe the transplant history, presenting features, treatment course and outcome of four additional patients who developed osteosarcoma following nonautologous BMT.…”

“…Their patient survived without evidence of either malignancy 10 years after BMT. 7 The second patient from the combined IBMTR/Seattle series, a boy transplanted for ANLL from an HLA-identical sibling at age 6.5 years, developed the osteosarcoma after a latency of 6.6 years and succumbed to the disease 2.4 years thereafter. 6 The third patient whom we were able to identify from the literature was a 44-year-old man who developed an osteosarcoma of the right iliac bone 5 years after an allogeneic BMT from his HLA-identical sister for acute monoblastic leukemia.…”