Basal Cell Skin Cancer after Total-Body Irradiation and Hematopoietic Cell Transplantation

Abstract

Previous studies identified radiation therapy as a key modifier of basal cell carcinoma (BCC) risk in survivors of hematopoietic cell transplantation (HCT). In the present analysis, risk of BCC was analyzed in relation to age at transplant, attained age, race, total-body irradiation (TBI), and radiation fractionation in 6,306 patients who received HCT at ages 0–65 years after conditioning regimens with (n = 3870) or without (n = 2436) TBI, and who were followed from 100 days to 36.2 years after HCT. While age-specific BCC rates in the unirradiated patient population were higher than those reported for two non-patient populations, the general characteristics were similar; rates increased with attained age, were eightfold lower for non-white patients, and were higher in more recent birth cohorts. After adjusting for these effects, risk in unirradiated patients did not vary significantly with age at HCT. The additional BCC risk associated with radiation exposure was largest for the youngest ages at exposure to radiation, with relative risks exceeding 20 for those transplanted at ages less than 10 years, and decreased with increasing age at exposure until age 40 years, above which no excess risk was identified. Relative risk in the irradiated population did not vary significantly with attained age, dose fractionation or race. Risks per unit dose in HCT patients were similar to other populations exposed under clinical settings to similar radiation doses and were more than 10-fold lower than seen in the atomic bomb survivors, 97% of whom were exposed to doses < 1 Sv.

How I monitor long-term and late effects after blood or marrow transplantation

“…73 TBI increases the risk of BCC, particularly among young patients. 74 Acute GVHD increases the risk of SCC; cGVHD increases the risk of both BCC and SCC. 1 BMT recipients are at a threefold increased risk of thyroid cancer when compared with an age-and sex-matched general population.…”

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

“…The data suggest an interaction with age, with higher risk of SN in younger recipients exposed to TBI compared with older patients. 39,125 However, the role of TBI in SN risk remains unresolved, with six publications providing strong evidence of increased SN risk from TBI exposure, 16,17,32,46,49,60 and eight studies failing to identify an association between TBI and SN. 22,24,33,37,38,41,59,69 …”

Skin Cancer Incidence among Atomic Bomb Survivors from 1958 to 1996

“…Dots show excess relative risk point estimates by age at exposure categories, 0-9, 10-19, 20-39, over 40 years old at the time of bombing and the 95% confidence bounds were also estimated. 536 40 years were estimated to be 15, 5.7, 1.3 and 0.19, respectively, while the corresponding estimates among patients with total body irradiation (TBI) for hematopoietic cell transplantation were 1.49, 0.55, 0.11 and 0.02, respectively (7). Also the EAR 1Gy of 0.053 cases per 10 4 PYs for LSS subjects was much lower than the estimates that were reported among medical exposures, such as 55.6 cases per 10 4 PYs for TBI exposure patients (7), 1.1 cases per 10 4 PYs for New York tinea capitis study series (5) and 0.31 cases per 10 4 PYs for Israel tinea capitis study (6).…”

“…An increased risk of skin cancer associated with exposure to ionizing radiation has been reported in various exposed populations, including the atomic bomb (A-bomb) survivors (1-3), uranium miners (4), radiologists and individuals treated with radiation in childhood for tinea capitis (5,6) and malignant tumors (7,8). The first report among the Abomb survivors in Hiroshima and Nagasaki by the Atomic Bomb Casualty Committee (ABCC) was 26 years after the A-bombs were dropped.…”

“…Age at exposure is one of the most significant modifiers of dose response for skin and many other cancers (1,5,7). The LSS subjects who were exposed in childhood have now reached cancer-prone ages.…”