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Second solid cancers after allogeneic hematopoietic cell transplantation using reduced-intensity conditioning.

Olle Ringdén1, Ruta Brazauskas2, Zhiwei Wang3

  • 1Center for Allogeneic Stem Cell Transplantation, Karolinka University Hospital, Stockholm, Sweden.

Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation
|July 22, 2014
PubMed
Summary

Reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (AHCT) shows overall second solid cancer risks similar to the general population. However, specific cancer sites, like the oropharynx, show increased risk in leukemia/myelodysplastic syndrome and lymphoma patients.

Keywords:
Hematopoietic cell transplantationNonmyeloablative conditioningReduced-intensity conditioningSecond cancersSolid tumors

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Area of Science:

  • Hematology
  • Oncology
  • Transplantation Medicine

Background:

  • Allogeneic hematopoietic cell transplantation (AHCT) is a curative therapy for hematologic malignancies.
  • Reduced-intensity conditioning (RIC) regimens have become increasingly utilized, offering a less toxic alternative to myeloablative conditioning (MAC).
  • Understanding the long-term risks of second solid cancers after RIC/nonmyeloablative conditioning (NMC) is crucial for patient management.

Purpose of the Study:

  • To evaluate the incidence and risk of second solid cancers following RIC/NMC for leukemia/myelodysplastic syndrome (MDS) and lymphoma.
  • To compare cancer risks between RIC/NMC and MAC in patients aged 40-60 years.

Main Methods:

  • Retrospective analysis of 2833 leukemia/MDS and 1436 lymphoma patients who underwent RIC/NMC between 1995-2006.
  • Comparison of 2138 RIC/NMC recipients aged 40-60 with 6428 MAC recipients of the same age.
  • Standardized incidence ratios (SIRs) and hazard ratios (HRs) were calculated to assess cancer risks.

Main Results:

  • The 10-year cumulative incidence of solid cancers was 3.35%.
  • Overall cancer risk was not elevated compared to the general population (SIR 0.99 for leukemia/MDS, 0.92 for lymphoma).
  • Significant increases in specific cancers (lip, tonsil, oropharynx, bone, soft tissue, vulva, skin melanoma) were observed in leukemia/MDS and lymphoma patients.
  • Age >50 years was an independent risk factor for solid cancers (HR 3.02).
  • No significant difference in cancer risk between RIC/NMC and MAC for leukemia/MDS patients (HR 0.98).
  • Lower cancer risk observed in lymphoma patients after RIC/NMC compared to MAC (HR 0.51).

Conclusions:

  • Overall risk of second solid cancers after RIC/NMC AHCT is comparable to the general population.
  • Certain cancer sites demonstrate a significantly elevated risk in specific patient groups.
  • Age is a key factor influencing solid cancer development post-transplant.
  • Further long-term follow-up studies are necessary to fully elucidate the risks of solid cancers after RIC/NMC AHCT.