Malignant neoplasms in long-term survivors of bone marrow transplantation
Malignant neoplasms in long-term survivors of bone marrow transplantation
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DOI：
10.7326/0003-4819-131-10-199911160-00004
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发表时间：
1999-11-16
影响因子：
39.2
通讯作者：
Prentice, HG
中科院分区：
文献类型：
--
作者：
Kolb, HJ;Socié, G;Prentice, HG
背景资料：接受骨髓移植的患者患新的恶性疾病的风险增加，因为有几个风险因素，包括放疗和化疗、免疫刺激和恶性原发病。必须评估长期存活者恶性肿瘤的发生率和风险因素目的：确定风险并定义骨髓移植后长期存活者新恶性肿瘤的潜在风险因素设计：回顾性多中心研究设置：与欧洲血液和骨髓移植合作组合作的45个移植中心的迟发效应工作组研究患者：1036例因白血病、淋巴瘤、造血和免疫系统先天性疾病或重度再生障碍性贫血而接受移植的连续患者。移植是在1985年12月之前完成的，并且患者已经存活了5年以上。测量：恶性肿瘤的报告进行了评估，并将其发病率与普通人群进行了比较。患者的年龄和性别，原发性疾病和移植时的状态，供体的组织相容性，预处理方案，移植物抗宿主病的预防类型，急性和慢性移植物抗宿主病的发展，和慢性移植物抗宿主病的治疗进行了评估为variables.Results：自移植后的中位随访时间为10.7年（范围，5至22.1年）。在53例患者中观察到恶性肿瘤; 10年时的精算发生率（+/- SE）为3.5% +/- 0.6%，15年时为12.8% +/- 2.6%。新发恶性肿瘤的发生率是年龄匹配的对照人群的3.8倍（P < 0.001）。最常见的恶性疾病是皮肤肿瘤（14例）、口腔肿瘤（7例）、子宫（包括宫颈）肿瘤（5例）、甲状腺肿瘤（5例）、乳腺肿瘤（4例）和胶质组织肿瘤（3例）。患者及其供体的中位年龄为21岁。恶性肿瘤在老年患者和慢性移植物抗宿主病患者中更常见。老年患者年龄和治疗慢性移植物抗宿主病与环孢素是显着的危险因素，新的恶性肿瘤后骨髓transplantation.Conclusions：肿瘤谱和免疫抑制治疗与环孢素慢性移植物抗宿主病的主要危险因素表明，免疫抑制是恶性肿瘤患者接受骨髓移植的主要原因。
Background: Patients who receive bone marrow transplants have increased risk for new malignant conditions because of several risk factors, including conditioning with radiation and chemotherapy, immune stimulation, and malignant primary disease. The occurrence of and risk factors for malignant neoplasm in long-term survivors must be assessed.Objective: To determine the risk and define potential risk factors for new malignant conditions in long-term survivors after marrow transplantation.Design: Retrospective multicenter study.Setting: Study of the Late Effects Working Party with 45 transplantation centers cooperating in the European Cooperative Group for Blood and Marrow Transplantation.Patients: 1036 consecutive patients who underwent transplantation for leukemia, lymphoma, inborn diseases of the hematopoietic and immune systems, or severe aplastic anemia. Transplantation was done before December 1985, and patients had survived more than 5 years.Measurements: Reports on malignant neoplasms were evaluated, and the incidence was compared to that in the general population. Patient age and sex, primary disease and status at transplantation, histocompatibility of the donor, conditioning regimen, type of prophylaxis of graft-versus-host disease, development of acute and chronic graft-versus-host disease, and treatment of chronic graft-versus-host disease were evaluated as variables.Results: Median follow-up since transplantation was 10.7 years (range, 5 to 22.1 years). Malignant neoplasms were seen in 53 patients; the actuarial incidence (+/- SE) was 3.5% +/- 0.6% at 10 years and 12.8% +/- 2.6% at 15 years. The rate of new malignant disease was 3.8-fold higher than that in an age-matched control population (P < 0.001). The most frequent malignant diseases were neoplasms of the skin (14 patients), oral cavity (7 patients), uterus (including cervix) (5 patients), thyroid gland (5 patients), breast (4 patients), and glial tissue (3 patients). Median age of patients and their donors was 21 years. Malignant neoplasms were more frequent in older patients and in patients with chronic graft-versus-host disease. Older patient age and treatment of chronic graft-versus-host disease with cyclosporine were significant risk factors for new malignant neoplasms after bone marrow transplantation.Conclusions: The spectrum of neoplasms and immunosuppressive treatment with cyclosporine for chronic graft-versus-host disease as dominant risk factors indicate that immunosuppression is the major cause of malignant neoplasms in patients receiving marrow transplants.