Impact of prior solid tumor on outcomes of hematopoietic stem cell transplantation for hematologic malignancies: a propensity score-matched study

The Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) assigns a high-risk score to patients who develop secondary hematologic malignancies following solid tumors, indicating an increased risk of non-relapse mortality (NRM). This study aimed to evaluate the impact of prior solid tumors on outcomes after hematopoietic stem cell transplantation (HSCT).

From a cohort of 2,382 patients who underwent HSCT for acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), or myelodysplastic syndrome (MDS) between January 2014 and July 2024, we included 43 (1.8%) with a history of prior solid tumors and 82 matched controls for analysis by 1:2 propensity score matching.

The solid tumor cohort predominantly comprised breast cancer (48.8%). With a median follow-up of 31.0 months, only one patient exhibited post-transplant relapse or metastasis of the solid tumor. Compared to the control group, patients with solid tumors exhibited higher ECOG scores (≥ 2: 23.1% vs. 9.5%, P = 0.049), lower platelet counts (35.5 vs. 72×10⁹/L, P = 0.010), a higher incidence of complex karyotypes (16.3% vs. 3.7%, P = 0.031). No significant differences were noted in 3-year overall survival (OS) (64.3% vs. 71.9%, P = 0.468), leukemia-free survival (LFS) (57.6% vs. 70.8%, P = 0.218), graft-versus-host disease/relapse-free survival (GRFS) (43.3% vs. 53.0%, P = 0.359) and NRM (23.9% vs. 11.7%, P = 0.246). In an exploratory landmark analysis, the solid tumor cohort appeared to have significantly lower OS (P = 0.030), LFS (P = 0.009), and GRFS (P = 0.038) from 2 years after transplantation. Multivariable analysis identified age greater than 55 years, baseline platelet counts less than 50×10⁹/L as significant predictors of inferior OS and LFS in solid tumor patients.

Patients with hematologic diseases secondary to solid tumors showed no significant increase in overall transplantation risk. However, their adverse clinical characteristics and reduced long-term survival rates beyond 2 years post-transplantation, underscore the need to refine HCT-CI scoring and improve management strategies.