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Solid cancers after bone marrow transplantation

R E Curtis1, P A Rowlings, H J Deeg

  • 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA.

The New England Journal of Medicine
|March 27, 1997
PubMed
Summary
This summary is machine-generated.

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Bone marrow transplant recipients face a significantly higher risk of developing new solid cancers, especially those who survive long-term. Younger patients and those receiving higher radiation doses are particularly vulnerable, necessitating lifelong monitoring.

Area of Science:

  • Hematology
  • Oncology
  • Transplantation Medicine

Background:

  • Late effects of bone marrow transplantation (BMT) require evaluation in at-risk populations.
  • Cancer development post-BMT is a significant concern.

Purpose of the Study:

  • To assess the risk of new solid cancer development after allogeneic or syngeneic bone marrow transplantation.
  • To identify risk factors associated with post-transplant cancer.

Main Methods:

  • A cohort of 19,229 patients undergoing BMT between 1964 and 1992 was studied.
  • Risk factors including patient age, transplant type, and post-transplant course were analyzed.
  • Observed cancer cases were compared to expected rates in the general population.

Main Results:

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  • BMT recipients had a 2.7-fold higher risk of new solid cancers compared to the general population.
  • The risk increased significantly with time post-transplant, reaching 8.3 times higher at 10+ years.
  • Specific cancers with elevated risk included melanoma, buccal cavity, liver, brain, thyroid, bone, and connective tissue cancers. Younger age at transplant and higher total-body irradiation doses were associated with increased risk.

Conclusions:

  • Bone marrow transplantation is associated with an increased long-term risk of solid cancers.
  • The rising risk over time and higher incidence in younger patients underscore the need for lifelong surveillance.
  • Chronic graft-versus-host disease and male sex were linked to specific squamous-cell cancers.