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Post-Transplant Complications

Second malignancy following high-dose therapy and autologous stem cell transplantation: incidence and risk factor analysis

Bone Marrow Transplantation volume 32, pages 915–923 (2003)Cite this article

Summary:

To establish incidence and risk factors for development of second malignant neoplasms after high-dose chemo/radiotherapy (HDT) and autologous hematopoietic stem cell transplantation (AHSCT), the case files of 800 consecutive patients who underwent AHSCT at our institution between June 1982 and December 2000 were reviewed. In all, 26 patients developed 29 second malignancies (nine myelodysplastic syndrome (MDS)/acute myelogenous leukemia (AML), 16 solid tumors and four lymphoproliferative disorders (LPDs)) for a 15-year cumulative incidence of 11% (95% confidence interval (CI), 5–18%). These second tumors occurred at a median of 68 (range 1.5–177) months following AHSCT. The relative risk (RR) compared to the general population of developing a second malignancy following AHSCT was 3.3 (CI 2.2–4.7) P<0.001. The RR of developing MDS/AML, LPD and a solid tumor was 47.2 (CI 21.5–89.5) P<0.001, 8.1 (2.2–20.7) P=0.002 and 1.98 (1.1–3.2) P=0.009, respectively. In multivariate analysis, age ⩾35 years at the time of AHSCT (P=0.001) and an interval from diagnosis to AHSCT ⩾36 months (P=0.03) were associated with a greater risk of developing a second malignancy. Patients who have undergone HDT and AHSCT are at significant risk for developing a second malignancy and should receive indefinite follow-up.

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Acknowledgements

We wish to acknowledge the contribution of the medical and nursing staff of East 6 Ward and BMT Daycare at the Vancouver General Hospital, the staff of 6 West Ward at the British Columbia Cancer Agency, the staff of 3B Ward at the British Columbia's Children's Hospital, and Ms Louise Myers for preparation of the manuscript and tables.

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Authors and Affiliations

  1. Division of Hematology, British Columbia Cancer Agency and Vancouver General Hospital, Vancouver, British Columbia, Canada

    D L Forrest, T J Nevill, A Le, D A Brockington, M J Barnett, J C Lavoie, S H Nantel, K W Song, J D Shepherd, H J Sutherland, C L Toze & D E Hogge

  2. Division of Hematopathology, British Columbia Cancer Agency and Vancouver General Hospital, Vancouver, British Columbia, Canada

    S C Naiman

  3. Department of Pediatrics, Division of Oncology, British Columbia's Children's Hospital and the University of British Columbia,

    J H Davis

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  1. D L Forrest
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Correspondence to D L Forrest.

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The Leukemia and Bone Marrow Transplantation Program of British Columbia

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Forrest, D., Nevill, T., Naiman, S. et al. Second malignancy following high-dose therapy and autologous stem cell transplantation: incidence and risk factor analysis. Bone Marrow Transplant 32, 915–923 (2003). https://doi.org/10.1038/sj.bmt.1704243

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