This Article Full Text Full Text (PDF) Erratum (v21,p3181) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Baker, K. S. Articles by Robison, L. L. Search for Related Content PubMed PubMed Citation Articles by Baker, K. S. Articles by Robison, L. L. Social Bookmarking                            What's this?

New Malignancies After Blood or Marrow Stem-Cell Transplantation in Children and Adults: Incidence and Risk Factors

K. Scott Baker, Todd E. DeFor, Linda J. Burns, Norma K.C. Ramsay, Joseph P. Neglia, Leslie L. Robison

From the Departments of Pediatrics and Medicine, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN.

Address reprint requests to K. Scott Baker, MD, Pediatric Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 484, Room D-557, Minneapolis, MN 55455; email: baker084{at}tc.umn.edu.

Purpose: To determine the incidence and risk factors for the development of new malignancies occurring after stem-cell transplantation (SCT). Patients: Between January 1, 1974, and March 31, 2001, 3,372 patients underwent SCT at the University of Minnesota. From these transplants, 147 posttransplant malignancies (PTMs) were identified in 137 patients.

Results: Excluding nonmelanoma skin cancers (n = 19) and carcinoma-in-situ (n = 5), the remaining 123 cases represented an 8.1-fold (95% confidence interval [CI], 6.7 to 9.6) increased risk of a PTM, an excess risk of 102.7 cases/10,000 persons/yr (age and sex adjusted). This includes a significantly elevated risk for developing myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML; standardized incidence ratio [SIR] = 300; 95% CI, 210 to 406), non-Hodgkin’s lymphoma including posttransplant lymphoproliferative disorder (PTLD; SIR = 54.3; 95% CI, 39.5 to 41.1), Hodgkin’s disease (SIR = 14.8; 95% CI, 3.9 to 32.9), or solid tumors overall (SIR = 2.8; CI, 2.0 to 3.7) and in specific for melanoma, brain, and oral cavity tumors. The cumulative incidence for the development of any PTM was 6.9% (95% CI, 5.2 to 8.6) at 20 years post-SCT. For PTLD (n = 43), the cumulative incidence plateaued at 1.4% (95% CI, 1.0 to 1.8) by 10 years post-SCT. For MDS or AML, the cumulative incidence plateaued at 1.4% (95% CI, 0.9 to 1.9) by 10 years post-SCT. The cumulative incidence of developing a solid tumor did not plateau and was 3.8% (95% CI, 2.2 to 5.4) at 20 years post-SCT.

Conclusion: These data reveal that the risk of PTMs, especially solid tumors, continues to increase even 20 years after transplant, necessitating long-term close follow-up for these patients.

Supported in part by National Institutes of Health grant no. 1K23CA85503-01A1 and ROI CA789383 (K.S.B.) and by support to the University of Minnesota from the Children’s Cancer Research Fund.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J. D. Rizzo, R. E. Curtis, G. Socie, K. A. Sobocinski, E. Gilbert, O. Landgren, L. B. Travis, W. D. Travis, M. E. D. Flowers, D. L. Friedman, et al. Solid cancers after allogeneic hematopoietic cell transplantation Blood, January 29, 2009; 113(5): 1175 - 1183. [Abstract] [Full Text] [PDF]

				P. A. Walker, S. K. Shah, M. T. Harting, and C. S. Cox Jr Progenitor cell therapies for traumatic brain injury: barriers and opportunities in translation Dis. Model. Mech., January 1, 2009; 2(1-2): 23 - 38. [Abstract] [Full Text] [PDF]

				C. L. Hollingsworth, D. P. Frush, J. Kurtzburg, and V. K. Prasad Pediatric Hematopoietic Stem Cell Transplantation and the Role of Imaging Radiology, August 1, 2008; 248(2): 348 - 365. [Abstract] [Full Text] [PDF]

				D. L. Friedman, A. Rovo, W. Leisenring, A. Locasciulli, M. E. D. Flowers, A. Tichelli, J. E. Sanders, H. J. Deeg, and G. Socie Increased risk of breast cancer among survivors of allogeneic hematopoietic cell transplantation: a report from the FHCRC and the EBMT-Late Effect Working Party Blood, January 15, 2008; 111(2): 939 - 944. [Abstract] [Full Text] [PDF]

				A. Cohen, A. Rovelli, D. F. Merlo, M. T. van Lint, E. Lanino, D. Bresters, M. Ceppi, V. Bocchini, A. Tichelli, and G. Socie Risk for Secondary Thyroid Carcinoma After Hematopoietic Stem-Cell Transplantation: An EBMT Late Effects Working Party Study J. Clin. Oncol., June 10, 2007; 25(17): 2449 - 2454. [Abstract] [Full Text] [PDF]

				J. D. Dickerman The Late Effects of Childhood Cancer Therapy Pediatrics, March 1, 2007; 119(3): 554 - 568. [Abstract] [Full Text] [PDF]

				W. Leisenring, D. L. Friedman, M. E.D. Flowers, J. L. Schwartz, and H. J. Deeg Nonmelanoma Skin and Mucosal Cancers After Hematopoietic Cell Transplantation J. Clin. Oncol., March 1, 2006; 24(7): 1119 - 1126. [Abstract] [Full Text] [PDF]

				C. J. Fraser, B. A. Hirsch, V. Dayton, M. H. Creer, J. P. Neglia, J. E. Wagner, and K. S. Baker First report of donor cell-derived acute leukemia as a complication of umbilical cord blood transplantation Blood, December 15, 2005; 106(13): 4377 - 4380. [Abstract] [Full Text] [PDF]

				D. L. Forrest, D. E. Hogge, T. J. Nevill, S. H. Nantel, M. J. Barnett, J. D. Shepherd, H. J. Sutherland, C. L. Toze, C. A. Smith, J. C. Lavoie, et al. High-Dose Therapy and Autologous Hematopoietic Stem-Cell Transplantation Does Not Increase the Risk of Second Neoplasms for Patients With Hodgkin's Lymphoma: A Comparison of Conventional Therapy Alone Versus Conventional Therapy Followed by Autologous Hematopoietic Stem-Cell Transplantation J. Clin. Oncol., November 1, 2005; 23(31): 7994 - 8002. [Abstract] [Full Text] [PDF]

				S. Bhatia, L. L. Robison, L. Francisco, A. Carter, Y. Liu, M. Grant, K. S. Baker, H. Fung, J. G. Gurney, P. B. McGlave, et al. Late mortality in survivors of autologous hematopoietic-cell transplantation: report from the Bone Marrow Transplant Survivor Study Blood, June 1, 2005; 105(11): 4215 - 4222. [Abstract] [Full Text] [PDF]

				R. E. Curtis, C. Metayer, J. D. Rizzo, G. Socie, K. A. Sobocinski, M. E. D. Flowers, W. D. Travis, L. B. Travis, M. M. Horowitz, and H. J. Deeg Impact of chronic GVHD therapy on the development of squamous-cell cancers after hematopoietic stem-cell transplantation: an international case-control study Blood, May 15, 2005; 105(10): 3802 - 3811. [Abstract] [Full Text] [PDF]

				J. R. Brown, H. Yeckes, J. W. Friedberg, D. Neuberg, H. Kim, L. M. Nadler, and A. S. Freedman Increasing Incidence of Late Second Malignancies After Conditioning With Cyclophosphamide and Total-Body Irradiation and Autologous Bone Marrow Transplantation for Non-Hodgkin's Lymphoma J. Clin. Oncol., April 1, 2005; 23(10): 2208 - 2214. [Abstract] [Full Text] [PDF]

				A. Tichelli and G. Socie Considerations for Adult Cancer Survivors Hematology, January 1, 2005; 2005(1): 516 - 522. [Abstract] [Full Text] [PDF]

				K. S. Baker, J. G. Gurney, K. K. Ness, R. Bhatia, S. J. Forman, L. Francisco, P. B. McGlave, L. L. Robison, D. S. Snyder, D. J. Weisdorf, et al. Late effects in survivors of chronic myeloid leukemia treated with hematopoietic cell transplantation: results from the Bone Marrow Transplant Survivor Study Blood, September 15, 2004; 104(6): 1898 - 1906. [Abstract] [Full Text] [PDF]

				S. Manne, K. DuHamel, J. Ostroff, S. Parsons, D. R. Martini, S. E. Williams, L. Mee, S. Sexson, J. Austin, J. Difede, et al. Anxiety, Depressive, and Posttraumatic Stress Disorders Among Mothers of Pediatric Survivors of Hematopoietic Stem Cell Transplantation Pediatrics, June 1, 2004; 113(6): 1700 - 1708. [Abstract] [Full Text] [PDF]