Second Solid Cancers after Allogeneic Hematopoietic Cell Transplantation Using Reduced-Intensity Conditioning

Ringdén, Olle; Brazauskas, Ruta; Wang, Zhiwei; Ahmed, Ibrahim; Atsuta, Yoshiko; Buchbinder, David; Burns, Linda J.; Cahn, Jean Yves; Duncan, Christine; Hale, Gregory A.; Halter, Joerg; Hayashi, Robert J.; Hsu, Jack W.; Jacobsohn, David A.; Kamble, Rammurti T.; Kamani, Naynesh; Kasow, Kimberly A.; Khera, Nandita; Lazarus, Hillard M.; Loren, Alison W.; Marks, David I.; Myers, Kasiani C.; Ramanathan, Muthalagu; Saber, Wael; Savani, Bipin N.; Schouten, Harry C.; Socié, Gèrard; Sorror, Mohamed L.; Steinberg, Amir; Popat, Uday; Wingard, John R.; Mattsson, Jonas; Majhail, Navneet S.

doi:10.1016/j.bbmt.2014.07.009

Cited by 58 publications

(62 citation statements)

References 32 publications

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“…3,5,11,12 Reports describing skin cancer following HCT are dominated by case reports, but at least five large studies have reported an increased incidence of melanoma after allogeneic HCT compared with the general population (SIR 1.4–8.3). 3,5,11–13 The risk of developing melanoma was also increased compared with the general population after HCT with reduced-intensity conditioning (RIC) regimens (SIR 3.04 for leukemia or myelodysplastic syndrome patients and SIR 3.52 for lymphoma patients). 13 An Asian study reported an increased incidence of skin cancers without distinguishing cancer subtypes after allogeneic HCT (SIR 7.2).…”

Section: Methodsmentioning

confidence: 99%

“…3,5,11–13 The risk of developing melanoma was also increased compared with the general population after HCT with reduced-intensity conditioning (RIC) regimens (SIR 3.04 for leukemia or myelodysplastic syndrome patients and SIR 3.52 for lymphoma patients). 13 An Asian study reported an increased incidence of skin cancers without distinguishing cancer subtypes after allogeneic HCT (SIR 7.2). 14 One study reported that the cumulative incidences of BCC and SCC were 6.5% and 3.4% at 20 years after allogeneic HCT in a predominantly Caucasian cohort.…”

Section: Methodsmentioning

confidence: 99%

“…3,5,11,14 The risk of oropharyngeal cancers was also elevated after HCT with RIC regimens (SIR 46.7). 13 The risk of oral SCC is particularly high in patients with cGVHD receiving long-term immunosuppressive therapy ⩾ 24 months. 4,5,11,13–15,29–31 There was an association between oral cancer and male gender.…”

Section: Methodsmentioning

confidence: 99%

“…13 The risk of oral SCC is particularly high in patients with cGVHD receiving long-term immunosuppressive therapy ⩾ 24 months. 4,5,11,13–15,29–31 There was an association between oral cancer and male gender. 5,11 In addition to cGVHD, conditioning regimens with limited field irradiation was associated with an increased risk of SCC of the oral cavity (RR = 4.7).…”

Section: Methodsmentioning

confidence: 99%

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Secondary solid cancer screening following hematopoietic cell transplantation

Inamoto¹,

Shah

Savani

et al. 2015

Bone Marrow Transplant

153

123

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Hematopoietic stem cell transplant (HCT) recipients have a substantial risk of developing secondary solid cancers, particularly beyond 5 years after HCT and without reaching a plateau overtime. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal to facilitate implementation of cancer screening appropriate to HCT recipients. The working group reviewed guidelines and methods for cancer screening applicable to the general population and reviewed the incidence and risk factors for secondary cancers after HCT. A consensus approach was used to establish recommendations for individual secondary cancers. The most common sites include oral cavity, skin, breast and thyroid. Risks of cancers are increased after HCT compared with the general population in skin, thyroid, oral cavity, esophagus, liver, nervous system, bone and connective tissues. Myeloablative TBI, young age at HCT, chronic GVHD and prolonged immunosuppressive treatment beyond 24 months were well-documented risk factors for many types of secondary cancers. All HCT recipients should be advised of the risks of secondary cancers annually and encouraged to undergo recommended screening based on their predisposition. Here we propose guidelines to help clinicians in providing screening and preventive care for secondary cancers among HCT recipients.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Secondary solid cancer screening following hematopoietic cell transplantation

Inamoto¹,

Shah

Savani

et al. 2015

Bone Marrow Transplant

153

123

View full text Add to dashboard Cite

show abstract

“…Longer follow-up is also needed to understand the full risks of secondary cancers after RIC regimens. 83 The comparison of risks of secondary malignancy after RIC or MAC remains inconclusive but the incidence of this complication may become clearer after a longer follow-up. 82 Other common, serious complications of HCT, particularly for men and women in their reproductive years, are hypogonadism and infertility.…”

Section: Long-term Complicationsmentioning

confidence: 99%

Reduced intensity conditioning allogeneic hematopoietic cell transplantation for adult acute myeloid leukemia in complete remission - a review from the Acute Leukemia Working Party of the EBMT

et al. 2015

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Acute myeloid leukemia is the most common indication for an allogeneic hematopoietic cell transplant. The introduction of reduced intensity conditioning has expanded the recipient pool for transplantation, which has importantly made transplant an option for the more commonly affected older age groups. Reduced intensity conditioning allogeneic transplantation is currently the standard of care for patients with intermediate or high-risk acute myeloid leukemia and is now most often employed in older patients and those with medical comorbidities. Despite being curative for a significant proportion of patients, post-transplant relapse remains a challenge in the reduced intensity conditioning setting. Herein we discuss the studies that demonstrate the feasibility of reduced intensity conditioning allogeneic transplants, compare the outcomes of reduced intensity conditioning versus chemotherapy and conventional myeloablative conditioning regimens, describe the optimal donor and stem cell source, and consider the impact of post-remission consolidation, comorbidities, center experience, and more intensive (reduced toxicity conditioning) regimens on outcomes. Additionally, we discuss the need for further prospective studies to optimize transplant outcomes. ABSTRACTas the backbone of most RIC regimens which also include either a reduced dose of an alkylating agent or a reduced dose of TBI. Fludarabine is generally well tolerated and synergizes well with alkylating agents to enhance inhibition of DNA repair mechanisms. 10 Multiple RIC regimens have been developed and described [12][13][14][15][16][17][18][19] (Table 1).In the late 1990s and early 2000s, the feasibility and efficacy of lower intensity conditioning regimens were demonstrated in several studies that showed successful engraftment in recipients of grafts from both related 19,20 and unrelated donors. 21,22 These regimens were also demonstrated to be a treatment modality that can be successful in older patients with hematologic malignancies. 23 McSweeney et al. described 45 patients with a median age of 56 years who had human leukocyte antigen (HLA)-identical sibling donors and relative contraindications to conventional conditioning for HCT. In these patients a conditioning regimen of TBI alone (200 cGy) produced a survival rate of >66% after a median follow-up of 417 days with a NRM rate of only 6.7%. The associated toxicities were mild, and over 50% of patients were able to have their transplant done completely in the outpatient setting. 23 This set the stage for future studies focusing on the potent immunological graft-versus-leukemia effect to induce cures as opposed to just on intensive pre-transplantation marrow ablative strategies.As the number of efficacious regimens grew, so did the number of patients for whom transplantation became a therapeutic option. Much enthusiasm has led to the widespread adoption of RIC HCT as a potentially curative option for older patients or those with comorbid disease, despite lack of supportive, prospective, randomized d...

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