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Blood, 29 January 2009, Vol. 113, No. 5, pp. 1175-1183.
Prepublished online as a Blood First Edition Paper on October 29, 2008; DOI 10.1182/blood-2008-05-158782.
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Submitted May 21, 2008
Accepted October 10, 2008
Solid cancers after allogeneic hematopoietic cell transplantation
J Douglas Rizzo*, Rochelle E Curtis, Gerard Socie, Kathleen A. Sobocinski, Ethel Gilbert, Ola Landgren, Lois B Travis, William D Travis, Mary E D Flowers, Debra L Friedman, Mary M Horowitz, John R Wingard, and H Joachim Deeg
Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, United States
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Hopital Saint Louis, Paris, France
Memorial Sloan Kettering Cancer Center, New York, NY, United States
Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Shands Hospital, Gainesville, FL, United States
* Corresponding author; email: rizzo{at}mcw.edu.
Transplant recipients have been reported to have an increased risk of solid cancers but most studies are small and have limited ability to evaluate the interaction of host, disease and treatment-related factors. In the largest study to date to evaluate risk factors for solid cancers, we studied a multi-institutional cohort of 28,874 allogeneic transplant recipients including 189 solid malignancies. Overall, patients developed new solid cancers at twice the rate expected based on general population rates (observed-to-expected ratio 2.1; 95% confidence interval 1.8, 2.5), with risk increasing over time (P trend<0.001); risk reached 3-fold among patients followed  15 years post-transplant. New findings showed that the risk of developing a non-squamous cell carcinoma (non-SCC) following conditioning radiation was highly dependent on age at exposure. Among patients irradiated at ages under 30 years, the relative risk of non-SCC was 9-times that of non-irradiated patients, while the comparable risk for older patients was 1.1 (P interaction <0.01). Chronic graft-versus-host disease and male sex were the main determinants for risk of SCC. These data indicate that allogeneic transplant survivors, particularly those irradiated at young ages, face increased risks of solid cancers, supporting strategies to promote lifelong surveillance among these patients.
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