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

Abstract

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.

• Authors: Y Atsuta, R Suzuki, T Yamashita, T Fukuda, K Miyamura, S Taniguchi, H Iida, T Uchida, K Ikegame, S Takahashi, K Kato, K Kawa, T Nagamura-Inoue, Y Morishima, H Sakamaki, Y Kodera, Japan Society for Hematopoietic Cell Transplantation
• Journal: Annals of oncology : official journal of the European Society for Medical Oncology (Ann Oncol) Vol. 25 Issue 2 Pg. 435-41 (Feb 2014) ISSN: 1569-8041 [Electronic] England
• PMID: 24399081 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Age Distribution
• Esophageal Neoplasms (epidemiology, etiology)
• Female
• Graft vs Host Disease (complications, epidemiology)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Incidence
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (therapy)
• Leukemia, Myeloid, Acute (therapy)
• Male
• Middle Aged
• Mouth Neoplasms (epidemiology, etiology)
• Neoplasms, Second Primary (epidemiology, etiology)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (therapy)
• Risk Factors
• Transplantation, Homologous
• Young Adult