Faculty Collaboration Database

Risk Factors for Subsequent Central Nervous System Tumors in Pediatric Allogeneic Hematopoietic Cell Transplant: A Study from the Center for International Blood and Marrow Transplant Research (CIBMTR). Biol Blood Marrow Transplant 2017 Aug;23(8):1320-1326

Date

04/16/2017

Pubmed ID

28411175

Pubmed Central ID

PMC5518678

DOI

10.1016/j.bbmt.2017.04.004

Scopus ID

2-s2.0-85019572284 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

Survivors of hematopoietic cell transplantation (HCT) are at risk of subsequent solid tumors, including central nervous system (CNS) tumors. The risk of CNS tumors after HCT in pediatric HCT recipients is not known. We evaluated the incidence and risk factors for CNS tumors in pediatric recipients of allogeneic HCT reported to the Center for International Blood and Marrow Transplant Research between 1976 and 2008. A case control design was used. There were no CNS tumors in the nonmalignant cohort (n = 4543) or in those undergoing HCT for solid tumors (n = 26). There were 59 CNS tumors in 8720 patients transplanted for hematologic malignancies. In comparison with the general population, pediatric HCT recipients with hematologic malignancies had a 33 times higher than expected rate of CNS tumors (95% confidence interval, 22.98 to 45.77; P < .0001). The cumulative incidence of subsequent CNS tumors was 1.29% (95% confidence interval .87 to 1.87) at 20 years after HCT. Significant risk factors in the entire cohort were having an unrelated donor (HR, 3.35; P = .0002) and CNS disease before HCT for both acute lymphoblastic leukemia (HR, 8.21; P = .0003) and acute myeloid leukemia (HR, 6.21; P = .0174). Analysis of the matched cohort showed having an unrelated donor transplant (HR, 4.79; P = .0037), CNS disease before HCT (HR, 7.67; P = .0064), and radiotherapy exposure before conditioning (HR, 3.7; P = .0234) to be significant risk factors. Chronic graft-versus-host disease was associated with a lower risk (HR, .29; P = .0143). Survivors of HCT for nonmalignant diseases did not show an increased incidence of CNS tumors, whereas survivors of hematologic malignancies have a markedly increased incidence of CNS tumors that warrants lifelong surveillance.

Author List

Gabriel M, Shaw BE, Brazauskas R, Chen M, Margolis DA, Sengelov H, Dahlberg A, Ahmed IA, Delgado D, Lazarus HM, Gibson B, Myers KC, Kamble RT, Abdel-Mageed A, Li CK, Flowers MED, Battiwalla M, Savani BN, Majhail N, Shaw PJ

Authors

Ruta Brazauskas PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
David A. Margolis MD Chair, Professor in the Pediatrics department at Medical College of Wisconsin
Bronwen E. Shaw MBChB, PhD Center Director, Professor in the Medicine department at Medical College of Wisconsin

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

Adolescent
Adult
Allografts
Central Nervous System Neoplasms
Child
Child, Preschool
Female
Hematologic Neoplasms
Hematopoietic Stem Cell Transplantation
Humans
Incidence
Infant
Leukemia, Myeloid, Acute
Male
Neoplasms, Second Primary
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Unrelated Donors