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Increased incidence of oral and gastrointestinal secondary cancer after allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 52, pages 789–791 (2017)Cite this article

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With an increasing number of long-term survivors after allogeneic hematopoietic stem cell transplantation (allo-HSCT), more attention has been paid to late complications, of which secondary cancer is particularly life-threatening.1, 2 The risk of developing solid tumors after allo-HSCT has been reported to be two- to fourfold higher than that in the general population, and the actual incidence of developing secondary solid cancers is 2–6% at 10 years after allo-HSCT.3, 4, 5 Risk factors include chronic GvHD,3, 5 use of radiation,5, 6 younger age,4, 6 male sex4, 5, 7 and immunosuppressive therapy.8 Atsuta et al.3 analyzed the risk of secondary cancer after allo-HSCT using the Japan transplant registry database of 17 545 patients, and showed a continuing increased risk of secondary cancers after allo-HSCT, with a standard incidence ratio (SIR) of 1.8 and a cumulative incidence of 1.7% at 10 years. They also indicated that the risks of developing esophageal and oral cancer were significantly increased after allo-HSCT in the Japanese population. To further clarify practical incidence rates and risk factors of secondary cancers, and to inform survivorship care protocols, we performed a retrospective, single-center study.

We evaluated data on patients who had a hematological disorder and received their first allo-HSCT at our center between 1982 and 2012. Data were extracted from a transplant registry database in which patient information including long-term complications, such as chronic GvHD and secondary cancer, are updated annually. A total of 1060 patients were included in the analysis. The probability of secondary cancers was estimated using the cumulative incidence method, and death without development of secondary cancers was treated as a competing risk. Gray’s method was used to evaluate the differences between groups. Patients who had relapse of underlying hematological malignancy after HSCT were censored at the date of relapse. SIRs of secondary cancers were calculated to evaluate the difference between the present cohort and the general population in terms of the incidence of secondary cancers after receiving allo-HSCT. The age-adjusted incidence of secondary cancers was based on the data from Cancer Information Service NCC, Japan Cancer Registry and Statistics.9 The exact Poisson distribution was used to calculate 95% confidence intervals (CI). In patients who developed multiple metachronous secondary cancers, the date that the first cancer developed was used in calculations of cumulative incidence and SIR. Multivariate analysis was performed using a competing risk regression by the method of Fine and Gray. Statistical analyses were performed with EZR version 1.27. This study was approved by the institutional review board of the National Cancer Center Hospital.

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Acknowledgements

This work was supported by grants from the National Cancer Research and Development Fund (26-A-26). We thank the medical, nursing, data-processing, laboratory and clinical staff at the National Cancer Center Hospital, Tokyo, Japan, for their important contributions to this study and their dedicated patient care.

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Authors and Affiliations

  1. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Y Tanaka, S Kurosawa, K Tajima, T Tanaka, R Ito, Y Inoue, K Okinaka, Y Inamoto, S Fuji, S-W Kim, T Yamashita & T Fukuda

  2. Department of Blood Transfusion and Cellular Therapy, National Cancer Center Hospital, Tokyo, Japan

    R Tanosaki

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  1. Y Tanaka
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Correspondence to S Kurosawa.

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Tanaka, Y., Kurosawa, S., Tajima, K. et al. Increased incidence of oral and gastrointestinal secondary cancer after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 52, 789–791 (2017). https://doi.org/10.1038/bmt.2017.4

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