Faculty Collaboration Database

Solid cancers after bone marrow transplantation. N Engl J Med 1997 Mar 27;336(13):897-904

Date

03/27/1997

Pubmed ID

9070469

DOI

10.1056/NEJM199703273361301

Scopus ID

2-s2.0-9844227997 (requires institutional sign-in at Scopus site)   818 Citations

Abstract

BACKGROUND: The late effects of bone marrow transplantation, including cancer, need to be determined in a large population at risk.

METHODS: We studied 19,229 patients who received allogeneic transplants (97.2 percent) or syngeneic transplants (2.8 percent) between 1964 and 1992 at 235 centers to evaluate the risk of the development of a new solid cancer. Risk factors relating to the patient, the transplant, and the course after transplantation were evaluated.

RESULTS: The transplant recipients were at significantly higher risk of new solid cancers than the general population (observed cases, 80; ratio of observed to expected cases, 2.7; P<0.001). The risk was 8.3 times higher than expected among those who survived 10 or more years after transplantation. The cumulative incidence rate was 2.2 percent (95 percent confidence interval, 1.5 to 3.0 percent) at 10 years and 6.7 percent (95 percent confidence interval, 3.7 to 9.6 percent) at 15 years. The risk was significantly elevated (P<0.05) for malignant melanoma (ratio of observed to expected cases, 5.0) and cancers of the buccal cavity (11.1), liver (7.5), brain or other parts of the central nervous system (7.6), thyroid (6.6), bone (13.4), and connective tissue (8.0). The risk was higher for recipients who were younger at the time of transplantation than for those who were older (P for trend <0.001). In multivariate analyses, higher doses of total-body irradiation were associated with a higher risk of solid cancers. Chronic graft-versus-host disease and male sex were strongly linked with an excess risk of squamous-cell cancers of the buccal cavity and skin.

CONCLUSIONS: Patients undergoing bone marrow transplantation have an increased risk of new solid cancers later in life. The trend toward an increased risk over time after transplantation and the greater risk among younger patients indicate the need for life-long surveillance.

Author List

Curtis RE, Rowlings PA, Deeg HJ, Shriner DA, Socíe G, Travis LB, Horowitz MM, Witherspoon RP, Hoover RN, Sobocinski KA, Fraumeni JF Jr, Boice JD Jr

Author

Mary M. Horowitz MD, MS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Age Factors
Analysis of Variance
Bone Marrow Transplantation
Child
Female
Follow-Up Studies
Graft vs Host Disease
Hematologic Diseases
Humans
Incidence
Leukemia
Male
Neoplasms, Radiation-Induced
Neoplasms, Second Primary
Radiation Dosage
Regression Analysis
Risk Factors
Time Factors
Whole-Body Irradiation