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Aggressive skin cancers in patients who experienced chronic GvHD after allogeneic bone marrow transplantation

Bone Marrow Transplantation volume 52, pages 130–131 (2017)Cite this article

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Treatment by allogeneic BMT has resulted in an increasingly large cohort of long-term survivors. However, the price of this success, as in organ transplant recipients, is the risk of cutaneous cancers.1 The 20-year cumulative incidence for skin cancers after a bone marrow transplant is 6.5% for basal cell carcinoma (BCC) and 3.4% for squamous cell carcinoma (SCC).2 Compared to the general population,3 the risk for BCC is 3.1 (95% confidence interval (CI), 1.9–5.2), for SCC is 18.3 (95% CI, 4.1–18.8) and for malignant melanoma (MM) it is 5.5 (95% CI, 1.7–17.7). The median interval from marrow transplantation to carcinoma diagnosis is 7.3–9.4 years for BCC and 2.1–7.0 years for SCC.2 The risk of skin melanoma in allogeneic transplant recipients is 3-fold higher than in renal transplant patients.3 Conditioning with total-body irradiation increases the risk of BCC (HR, 3.9 (95% CI, 2.6–6.8)).3 GvHD is an independent risk factor for skin cancers after BMT.4, 5, 6, 7 Curtis et al.5 showed that the risk for SCC among bone marrow transplant recipients who developed chronic GvHD was nearly 3-fold higher (relative risk (RR)=2.79) than in patients with no acute and no chronic GvHD. Major risk factors for the development of SCC were long duration of chronic GvHD therapy (P<0.001), the use of azathioprine, particularly when combined with cyclosporine and steroids (P<0.001), and severe chronic GvHD (P=0.004). No increase in risk was found for BCC or MM.5

The large series reporting skin carcinoma risk in hematologic patients are retrospective studies based on national registries. In consequence, there are no data on the severity of the lesions. Most patients experiencing GvHD are referred to dermatologists because of the prevalence of skin symptoms. We decided therefore to characterize the skin cancers observed in this patient population.

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Authors and Affiliations

  1. Department of Dermatology, Université d’Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France

    A S Zampaolo & M D'Incan

  2. Regional Center for Pediatric Cancerology and Cell Therapy, Université d’Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France

    J Kanold

  3. Department of Hematology, Université d’Auvergne 1, CHU Clermont Ferrand, Clermont-Ferrand, France

    O Tournilhac

  4. Department of Pathology, Université d’Auvergne 1, CHU Clermont-Ferrand, Clermont-Ferrand, France

    F Franck & M Bachelerie

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  1. A S Zampaolo
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Correspondence to A S Zampaolo.

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Zampaolo, A., Kanold, J., Tournilhac, O. et al. Aggressive skin cancers in patients who experienced chronic GvHD after allogeneic bone marrow transplantation. Bone Marrow Transplant 52, 130–131 (2017). https://doi.org/10.1038/bmt.2016.187

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