Malignancies after marrow transplantation for aplastic anemia and Fanconi anemia: A joint Seattle and Paris analysis of results in 700 patients
Malignancies after marrow transplantation for aplastic anemia and Fanconi anemia: A joint Seattle and Paris analysis of results in 700 patients
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DOI：
10.1182/blood.v87.1.386.bloodjournal871386
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发表时间：
1996-01-01
期刊：
影响因子：
20.3
通讯作者：
Storb, R
中科院分区：
文献类型：
--
作者：
Deeg, HJ;Socie, G;Storb, R
骨髓移植后发生新的（继发性）恶性肿瘤的危险因素仍不完全确定。在本研究中，我们分析了在华盛顿州西雅图的弗雷德哈钦森癌症研究中心或法国巴黎的圣刘易斯医院接受同种异体骨髓移植治疗的700例重度再生障碍性贫血患者的结果。23例患者在移植后1.4至221个月（中位数，91个月）发生恶性肿瘤，Kaplan-Meier估计20年时为14%（95%置信区间，4%至24%）。5例为淋巴恶性肿瘤（2例急性淋巴细胞白血病和3例淋巴增生性疾病），发生在移植后1.4至14.6个月（中位数，3个月），18例为实体瘤（17例鳞状细胞癌和1例粘液表皮样癌），发生在移植后30至221个月（中位数，99个月）。因此，淋巴恶性肿瘤的危险在移植后迅速下降，而实体瘤的危险随着移植后时间的推移而逐渐增加。单变量分析中确定的实体瘤的危险因素包括范可尼贫血的基础诊断（P=.0002），硫唑嘌呤治疗慢性移植物抗宿主病（GVHD）（P
Risk factors for the development of a new (secondary) malignancy after marrow transplantation are still incompletely defined. In the present study, we analyzed results in 700 patients with severe aplastic anemia treated with allogeneic marrow transplantation at the Fred Hutchinson Cancer Research Center in Seattle WA, or at the Hopital St Louis in Paris, France. Twenty three patients developed a malignancy 1.4 to 221 months (median, 91 months) after transplantation for a Kaplan-Meier estimate of 14% (95% confidence interval, 4% to 24%) at 20 years. Five cases were lymphoid malignancies (two acute lymphoblastic leukemias and three lymphoproliferative disorders) occurring 1.4 to 14.6 months (median, 3 months) posttransplant and 18 were solid tumors (17 squamous cell and one mucoepidermoid carcinoma) presenting 30 to 221 months (median, 99 months) posttransplant. Thus, the hazard for lymphoid malignancies declined rapidly posttransplant, while the hazard for solid tumors increased progressively with time posttransplant. Risk factors for solid tumors identified in univariable analysis included the underlying diagnosis of Fanconi anemia (P=.0002), azathioprine therapy for chronic graft-versus-host disease (GVHD) (P