New malignancies after blood or marrow stem-cell transplantation in children and adults: Incidence and risk factors
New malignancies after blood or marrow stem-cell transplantation in children and adults: Incidence and risk factors
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DOI：
10.1200/jco.2003.05.108
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发表时间：
2003-04-01
影响因子：
45.3
通讯作者：
Robison, LL
中科院分区：
文献类型：
--
作者：
Baker, KS;Defor, TE;Robison, LL
目的：探讨干细胞移植(SCT)后新恶性肿瘤的发生率和危险因素。患者：1974年1月1日至2001年3月31日，明尼苏达大学接受SCT的患者3372例。结果：排除19例非黑色素瘤皮肤癌和5例原位癌，其余123例发生恶性皮肤癌的风险增加了8.1倍(95%可信区间为6.7%~9.6%)，超额风险为102.7例/10,000人/年(调整了年龄和性别)。这包括显著升高的。发生骨髓增生异常综合征(MDS)或急性髓系白血病(AML；标准化发病率[SIR]=300；95%CI，210至406)、包括移植后淋巴增殖性疾病(PTLD；SIR=54.3；95%CI，39.5至41.1)在内的非霍奇金淋巴瘤、霍奇金病(SIR=14.8；95%CI，3.9至32.9)或实体瘤(SIR=2.8；CI，2.0至3.7)，尤其是黑色素瘤、脑和口腔肿瘤的风险。SCT后20年，任何PTM的累积发生率为6.9%(95%可信区间，5.2~8.6)。对于PTLD(n=43)，到SCT后10年，累积发病率稳定在1.4%(95%CI，1.0~1.8)。对于MDS或AML，到SCT后10年，累积发病率稳定在1.4%(95%CI，0.9至1.9)。SCT后20年实体瘤的累积发生率为3.8%(95%CI，2.2~5.4)。结论：即使在移植后20年，PTMS，特别是实体瘤的风险仍在继续增加，需要对这些患者进行长期密切的随访。(C)2003年，由美国临床肿瘤学会提供。
Purpose: To determine the incidence and risk factors for the development of new malignancies occurring after stem-cell transplantation (SCT).Patients: Between January 1, 1974, and March 31, 2001, 3,372 patients underwent SCT at the University of Minnesota. From these transplants, 147 posttransplant malignancies (PTMs) were identified in 137 patients.Results: Excluding nonmelanoma skin cancers (n = 19) and carcinoma-in-situ (n = 5), the remaining 123 cases represented an 8.1-fold (95% confidence interval [CI], 6.7 to 9.6) increased risk of a PTM, an excess risk of 102.7 cases/ 10,000 persons/yr (age and sex adjusted). This includes a significantly elevated. risk for developing myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML; standardized incidence ratio [SIR] = 300; 95% CI, 210 to 406), non-Hodgkin's lymphoma including posttransplant lymphoproliferative disorder (PTLD; SIR = 54.3; 95% CI, 39.5 to 41.1), Hodgkin's disease (SIR = 14.8; 95% CI, 3.9 to 32.9), or solid tumors overall (SIR = 2.8; CI, 2.0 to 3.7) and in specific for melanoma, brain, and oral cavity tumors. The cumulative incidence for the development of any PTM was 6.9% (95% CI, 5.2 to 8.6) at 20 years post-SCT. For PTLD (n = 43), the cumulative incidence plateaued at 1.4% (95% CI, 1.0 to 1.8) by 10 years post-SCT. For MDS or AML, the cumulative incidence plateaued at 1.4% (95% CI, 0.9 to 1.9) by 10 years post-SCT. The cumulative incidence of developing a solid tumor did not plateau and was 3.8% (95% CI, 2.2 to 5.4) at 20 years post-SCT.Conclusion: These data reveal that the risk of PTMs, especially solid tumors, continues to increase even 20 years after transplant, necessitating long-term close follow-up for these patients. (C) 2003 by American Society of Clinical Oncology.