Secondary
malignancies after marrow
transplantation have been observed in 20 patients: 19 patients underwent marrow
transplantation for the treatment of a hemopoietic
malignancy and one for
aplastic anemia. All but three were given total body irradiation at doses of 8.0-15.75 Gy as part of the conditioning regimen. Secondary
malignancies were composed of three groups: (a) Six patients had recurrence of
leukemia (three acute lymphoblastic, two acute myeloblastic, and one chronic myelocytic) in cells of donor origin 62-1074 days after grafting. (b) Eight patients developed
lymphoproliferative disorders (four of
immunoblastic sarcoma type, one lymphoblastic, one follicular center cell, and one
Hodgkin's lymphoma and one
acute lymphoblastic leukemia) 54-730 days after grafting. In four of seven patients with appropriate studies these
tumors were of donor-cell origin and in three of four tested the cells contained Epstein-Barr virus genome or expressed
viral antigens. (c) Six patients developed solid
tumors (two
glioblastoma multiforme, two
adenocarcinomas, one
squamous cell carcinoma, and one
sarcoma) 347-1875 days after grafting. All but two patients (one with
glioblastoma and one with
squamous cell carcinoma) have died. These data suggest that patients undergoing marrow
transplantation for a hemopoietic
malignancy may be at risk of developing secondary
malignancies. The etiology appears to be multifactorial, including irradiation, immunosuppression,
Epstein-Barr virus infections, and other factors.