Continuing increased risk of oral/esophageal cancer after allogeneic hematopoietic stem cell transplantation in adults in association with chronic graft-versus-host disease

Atsuta, Y.; Suzuki, R.; Yamashita, T.; Fukuda, T.; Miyamura, K.; Taniguchi, S.; Iida, H.; Uchida, T.; Ikegame, K.; Takahashi, S.; Kato, K.; Kawa, K.; Nagamura-Inoue, T.; Morishima, Y.; Sakamaki, H.; Kodera, Y.
February 2014
Annals of Oncology;Feb2014, Vol. 25 Issue 2, p435
Academic Journal
Recipients of allogeneic hematopoietic stem cell transplant had a significantly higher risk of developing secondary solid cancers than the general population. Risk of developing oral/pharynx or esophageal cancer continued to increase with time after transplant. Extensive-type chronic graft-versus-host disease and older age were a significant risk factor for developing secondary solid cancers.Background The number of long-term survivors after hematopoietic stem cell transplantation (HSCT) showed steady increase in the past two decades. Second malignancies after HSCT are a devastating late complication. We analyzed the incidence of, risk compared with that in the general population, and risk factors for secondary solid cancers. Patients and methods Patients were 17 545 adult recipients of a first allogeneic stem cell transplantation between 1990 and 2007 in Japan. Risks of developing secondary solid tumors were compared with general population by using standard incidence ratios (SIRs). Results Two-hundred sixty-nine secondary solid cancers were identified. The cumulative incidence was 0.7% [95% confidence interval (CI), 0.6%–0.9%] at 5 years and 1.7% (95% CI, 1.4%–1.9%) at 10 years after transplant. The risk was significantly higher than that in the general population (SIR = 1.8, 95% CI, 1.5–2.0). Risk was higher for oral cancer (SIR = 15.7, 95% CI, 12.1–20.1), esophageal cancer (SIR = 8.5, 95% CI, 6.1–11.5), colon cancer (SIR = 1.9, 95% CI, 1.2–2.7), skin cancer (SIR = 7.2, 95% CI, 3.9–12.4), and brain/nervous system cancer (SIR = 4.1, 95% CI, 1.6–8.4). The risk of developing oral, esophageal, or skin cancer was higher at all times after 1-year post-transplant. Extensive-type chronic graft-versus-host disease (GVHD) was a significant risk factor for the development of all solid tumors (RR = 1.8, P < 0.001), as well as for oral (RR = 2.9, P < 0.001) and esophageal (RR = 5.3, P < 0.001) cancers. Limited-type chronic GVHD was an independent risk factor for skin cancers (RR = 5.8, P = 0.016). Conclusion Recipients of allogeneic HSCT had a significantly higher ∼2-fold risk of developing secondary solid cancers than the general population. Lifelong screening for high-risk organ sites, especially oral or esophageal cancers, is important for recipients with active, or a history of, chronic GVHD.


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