Secondary malignancies after allogeneic stem-cell transplantation in the era of reduced-intensity conditioning; the incidence is not reduced (original) (raw)

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Leukemia volume 27, pages 829–835 (2013)Cite this article

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Abstract

Secondary malignancies are well established complication in long-term survivors after allogeneic stem-cell transplantation (SCT) with myeloablative conditioning (MAC). Fludarabine-based reduced-intensity (RIC) and reduced-toxicity conditioning (RTC) regimens are increasingly used in the last decade; however, due to limited long-term follow-up, there is no data on secondary malignancies in this setting. The records of 931 consecutive patients given allogeneic SCT with MAC (_n_=257), RIC (_n_=449) or RTC (_n_=225), in a single institution over a 13-year period, were reviewed. Twenty-seven patients had secondary malignancy, diagnosed a median of 43 months (7 months–11.5 years) after SCT. The 10-year cumulative incidence was 5.6% (95% confidence interval (CI), 3.6–8.7), twice the expected rate in matched normal population. The incidence was 1.7, 7.4 and 5.7% after MAC, RIC and RTC, respectively (_P_=0.02). Multivariate analysis identified fludarabine-based conditioning (hazard ratio (HR) 3.5, _P_=0.05), moderate–severe chronic graft-versus-host disease (HR 2.8, _P_=0.01) and diagnosis of chronic myeloproliferative or non-malignant disease (HR 0.2, _P_=0.04) as risk-factors for secondary malignancy. The related 10-year mortality rate was 2.4% (95% CI, 1.0–5.4). In conclusion, the risk of secondary malignancies is not reduced and is even possibly increased in the era of fludarabine-based RIC/RTC. Patients and physicians should be aware of this association and life-long cancer screening is required for all transplant survivors.

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Authors and Affiliations

  1. The Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
    A Shimoni, N Shem-Tov, Y Volchek, E Tallis, A Avigdor, R Yerushalmi & A Nagler
  2. Cancer and Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
    A Chetrit & S Sadetzki

Authors

  1. A Shimoni
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  2. N Shem-Tov
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  3. A Chetrit
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  4. Y Volchek
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  5. E Tallis
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  6. A Avigdor
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  7. S Sadetzki
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  8. R Yerushalmi
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  9. A Nagler
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Correspondence toA Shimoni.

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Shimoni, A., Shem-Tov, N., Chetrit, A. et al. Secondary malignancies after allogeneic stem-cell transplantation in the era of reduced-intensity conditioning; the incidence is not reduced.Leukemia 27, 829–835 (2013). https://doi.org/10.1038/leu.2012.299

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