Risk Stratification Models for Cutaneous Malignant Neoplasms After Blood or Marrow Transplant

Area of Science:

• Oncology
• Transplantation Medicine
• Dermatology

Background:

• Blood or marrow transplant (BMT) recipients have an elevated risk of developing secondary skin cancers (cutaneous malignant neoplasms).
• Effective risk stratification tools are crucial for optimizing dermatologic surveillance and implementing risk mitigation strategies in this population.

Purpose of the Study:

• To develop and validate a predictive tool for subsequent cutaneous malignant neoplasms in BMT recipients.
• The tool incorporates easily accessible patient and treatment data for risk assessment.

Main Methods:

• A prognostic study utilized data from the multi-institutional BMT Survivor Study (BMTSS), including patients who underwent autologous or allogeneic BMT between 1974 and 2014.
• Risk models were built using variables such as age at BMT, sex, race, prior skin cancer, TBI, GVHD, and immunosuppression.
• Model performance was assessed using time-dependent AUC with repeated random partitioning for training and testing cohorts.

Main Results:

• The study included 3448 BMTSS participants; 8.2% developed basal cell carcinoma (BCC), 5.3% squamous cell carcinoma (SCC), and 2.1% melanoma.
• At 15 years post-BMT, the risk stratification models showed high predictive accuracy (AUCs ranging from 0.81 to 0.90).
• Fifteen-year cumulative incidence of BCC, SCC, and melanoma was significantly higher in the high-risk group (13.3%, 13.6%, 4.4%) compared to the low-risk group (2.4%, 3.2%, 0.8%).

Conclusions:

• Developed risk stratification models demonstrate excellent performance in identifying BMT recipients at high risk for subsequent cutaneous malignant neoplasms.
• These models hold significant potential for guiding clinical practice in dermatologic surveillance and risk management for BMT survivors.