Subsequent malignancies after allogeneic hematopoietic stem cell transplantation

Abstract

We evaluated 979 patients for the development of post- transplant lymphoproliferative disease (PTLD) and solid malignancies after allogeneic hematopoietic stem cell trans-plantations (allo- HSCT) as a late complication. We found 15 (1.5%) subsequent malig-nancies; three of these malignancies were PTLD, and twelve were solid tumors. The median time from allo- HSCT to the development of PTLD was 9 (3- 20) months and that from allo- HSCT to the development of solid tumors was 93 (6- 316) months. The cumu-lative incidence of evolving subsequent malignancy in patients was 1.3% (±0.5 SE) at 5 years and 3.9% (±1.2 SE) at 10 years. The cumulative incidence of developing subse-quent malignancy in patients with benign hematological diseases as the transplant indi-cation was 7.4%±4.2 SE at 5 years. More subsequent malignancy developed in patients having ?1 year chronic graft- vs- host disease (GVHD; 3.7% in ?1 year chronic GVHDand 0.7% in <1 year chronic GVHD patient groups, P=.002). Subsequent epithelial tumor risk was higher in ?1 year chronic GVHD patients than <1 year (3.7% vs 0.1%,P<.001). In multivariate analysis, benign hematological diseases as transplant indication (RR: 5.6, CI 95%: 1.4- 22.3, P=.015) and ?1 year chronic GVHD (RR: 7.1, 95% CI: 2.3- 22.5, P=.001) were associated with the development of subsequent malignancy.