Survival of patients who develop solid tumors following hematopoietic stem cell transplantation

Ehrhardt, Matthew J.; Brazauskas, Ruta; He, Weizhong; Rizzo, J. Douglas; Shaw, Bronwen E.

doi:10.1038/bmt.2015.203

Cited by 28 publications

(29 citation statements)

References 23 publications

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“…These findings are in line with published results from the Center for International Blood and Marrow Transplant Research on survival in a cohort of 112 patients who developed a solid tumor after HSCT. 19 Of note, the outcome of many SSC types was similar for patients treated with autologous and allogeneic HSCT. A discrepancy was found, however, with better outcome after allogeneic HSCT for endometrial, sarcoma, gastric, melanoma, and kidney cancers.…”

Section: Discussionmentioning

confidence: 97%

Evaluation of Second Solid Cancers After Hematopoietic Stem Cell Transplantation in European Patients

et al. 2019

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Incidence and risk factors of second solid cancers (SSCs) that occur after hematopoietic stem cell transplantation (HSCT) are well documented. However, clinical outcome data of patients who developed an SSC after HSCT are limited. OBJECTIVE To assess the outcome of patients with an SSC occurring after HSCT from the time of SSC diagnosis. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data of 4065 patients from 26 countries registered with the European Society for Blood and Marrow Transplantation, which has maintained clinical data since 1977 of patients who received a transplant. Information from all patients who underwent a transplant in Europe and had an SSC diagnosis between January 1, 2000, and December 31, 2014, was extracted. The cohort included patients with 18 different cancers. Data analysis was conducted from September 3, 2017, to March 17, 2018. MAIN OUTCOMES AND MEASURES Median and 5-year age-standardized overall survival, causes of death, risk factor multivariate analysis using a clustered Cox proportional hazard regression model, and standardized mortality ratio were calculated for each of the 18 types of SSC. RESULTS In total, 220 617 patients underwent a transplant, of whom only 4065 (1.8%) patients with a second solid cancer after HSCT were included in the study. Among the 4065 patients, 2321 (57.1%) were men and 1744 (42.9%) were women, with a mean (range) age of 59.1 (3.2-82.3) years at diagnosis of second solid cancer. The 5-year age-standardized overall survival was 47% (95% CI, 45%-49%). The 5-year overall survival rate after SSC diagnosis was poor for pancreas, lung, hepatobiliary, esophageal, brain, and gastric cancers, with a median survival between 0.6 and 1 year. The 5-year overall survival was intermediate for endometrial, colorectal, sarcomas, ovarian, bladder, oropharyngeal, and kidney cancers, with a median survival between 2 and 10 years. The 5-year overall survival was more favorable for melanoma, breast, prostate, cervix, and thyroid cancers, with a median survival of 10 or more years. Additional transplant-associated factors for mortality for patients treated with allogeneic HSCT were age at transplant, donor type, conditioning regimen, and graft-vs-host disease. In total, 1777 patients (43.7%) died, of which 1256 (74.8%) were from SSC, 344 (20.5%) from primary disease, and 79 (4.7%) from other causes. Standardized mortality ratio was higher, compared with de novo solid cancers, for melanoma, prostate, breast, kidney, bladder, colorectal, and endometrial cancers but not for the other cancers. CONCLUSIONS AND RELEVANCE The outcome of SSC is mainly dependent on the type of second cancer; thus, future studies should investigate the reasons the standardized mortality ratio is higher for some cancers to identify whether patients with these cancers should be treated differently and to help in screening and counseling patients who developed an SSC after HSCT.

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Section: Discussionmentioning

confidence: 97%

Evaluation of Second Solid Cancers After Hematopoietic Stem Cell Transplantation in European Patients

et al. 2019

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“…190 For solid tumors, outcomes after allogeneic HCT appear to vary by tumor type, with poorer prognosis compared with the general population for female reproductive, bone and joint, lower gastrointestinal tract, and central nervous system (CNS) tumors, but comparable outcomes for thyroid, testis, breast, oral cavity, and soft tissue tumors, as well as melanoma. 191 …”

Section: Discussionmentioning

confidence: 99%

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report

Morton

Saber

Baker

et al. 2017

Biology of Blood and Marrow Transplantation

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Subsequent neoplasms (SN) following hematopoietic cell transplantation (HCT) cause significant patient morbidity and mortality. Risks for specific SN types vary substantially, with particularly elevated risks for post-transplant lymphoproliferative disorders, myelodysplastic syndrome/acute myeloid leukemia, and squamous cell malignancies. This consensus document provides an overview of the current state of knowledge regarding SN after HCT and recommends priorities and approaches to overcome challenges and gaps in understanding. Numerous factors have been suggested to impact risk, including patient-related (e.g., age), primary disease-related (e.g., disease type, pre-HCT therapies), and HCT-related characteristics (e.g., type and intensity of conditioning regimen, stem cell source, development of graft-versus-host disease). However, gaps in understanding remain for each of these risk factors, particularly for patients receiving HCT in the current era due to substantial advances in clinical transplantation practices. Additionally, the influence of non-transplant-related risk factors (e.g., germline genetic susceptibility, oncogenic viruses, lifestyle factors) is poorly understood. Clarification of the magnitude of SN risks and identification of etiologic factors will require large-scale, long-term, systematic follow-up of HCT survivors with detailed clinical data. Most investigations of the mechanisms of SN pathogenesis after HCT have focused on immune drivers. Expansion of our understanding in this area will require interdisciplinary laboratory collaborations utilizing measures of immune function and availability of archival tissue from SN diagnoses. Consensus-based recommendations for optimal preventative, screening, and therapeutic approaches have been developed for certain SN after HCT, whereas for other SN, general population guidelines are recommended. Further evidence is needed to specifically tailor preventative, screening, and therapeutic guidelines for SN after HCT, particularly for unique patient populations. Accomplishment of this broad research agenda will require increased investment in systematic data collection with engagement from patients, clinicians, and interdisciplinary scientists in order to reduce the burden of SN in the rapidly growing population of HCT survivors.

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“…For solid tumors, outcomes after allogeneic are variable, with poorer prognosis for female reproductive, bone and joint, lower gastrointestinal tract, and central nervous system tumors but with comparable outcomes for thyroid, testis, breast, oral cavity, soft tissue tumors, and melanoma [47]. …”

Section: Potentially Lethal Late Effectsmentioning

confidence: 99%

Long-Term Survivorship after Hematopoietic Cell Transplantation: Roadmap for Research and Care

Battiwalla

Thewis

Majhail

2017

Biology of Blood and Marrow Transplantation

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The number of survivors after hematopoietic cell transplantation (HCT) is expected to dramatically increase over the next decade. Significant and unique challenges confront survivors for decades after their underlying indication (malignancy or marrow failure) has been cured by HCT. The National Institutes of Health (NIH) Late Effects Consensus Conference in June 2016 brought together international experts in the field to plan the next phase of survivorship efforts. Working groups laid out the roadmap for collaborative research and health care delivery. Potentially lethal late effects (cardiac/vascular, subsequent neoplasms, and infectious), patient-centered outcomes, health care delivery, and research methodology are highlighted here. Important recommendations from the NIH Consensus Conference provide fresh perspectives for the future. As HCT evolves into a safer and higher-volume procedure, this marks a time for concerted action to ensure that no survivor is left behind.

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Survival of patients who develop solid tumors following hematopoietic stem cell transplantation

Cited by 28 publications

References 23 publications

Evaluation of Second Solid Cancers After Hematopoietic Stem Cell Transplantation in European Patients

Evaluation of Second Solid Cancers After Hematopoietic Stem Cell Transplantation in European Patients

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report

Long-Term Survivorship after Hematopoietic Cell Transplantation: Roadmap for Research and Care

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