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Arain A, Matthiesen C. Vitamin D deficiency and graft-versus-host disease in hematopoietic stem cell transplant population. Hematol Oncol Stem Cell Ther 2019; 12:133-139. [DOI: 10.1016/j.hemonc.2018.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/09/2018] [Accepted: 08/04/2018] [Indexed: 12/24/2022] Open
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Nicholson MC, Pavenski K, Trinkaus M. A case for consideration by apheresis practitioners: Melanoma and PD-1 inhibitor treatment in a patient with multiple relapses of immune thrombotic thrombocytopenic purpura. Transfus Apher Sci 2019; 58:123-124. [PMID: 30917902 DOI: 10.1016/j.transci.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Thrombotic Thrombocytopenic Purpura (TTP) is a rare life-threatening disease caused by ADAMTS-13 deficiency. Up to forty percent of patients with TTP relapse, and most relapse within eight years of their first presentation. This case report describes a patient with an aggressive course of TTP who subsequently developed metastatic melanoma while receiving prophylactic rituximab. Limited data exists regarding the potential for malignancy in patients receiving Rituximab for benign conditions. This is the first published case of melanoma in a TTP patient treated with rituximab. Melanoma treatment with PD-1 inhibitors is also associated with worsening of pre-existing autoimmune conditions. In this case, a splenectomy resulted in a durable remission despite treatment with PD-1 inhibitor.
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Affiliation(s)
- Matthew C Nicholson
- Division of Hematology, Department of Medicine, University of British Columbia, Canada
| | - Katerina Pavenski
- Departments of Medicine and Laboratory Medicine, St. Michael's Hospital and University of Toronto, Canada.
| | - Martina Trinkaus
- Departments of Medicine, St. Michael's Hospital and University of Toronto, Canada
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Wu PA, Stern RS, Huang V, Liu KX, Chen CA, Tzachanis D, Joyce RM, Davis RB, Ho VT. Reduced-Intensity Conditioning Regimens, Prior Chronic Lymphocytic Leukemia, and Graft-Versus-Host Disease Are Associated with Higher Rates of Skin Cancer after Allogeneic Hematopoietic Stem Cell Transplantation. J Invest Dermatol 2019; 139:591-599. [PMID: 30316899 DOI: 10.1016/j.jid.2018.08.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 12/22/2022]
Abstract
To assess incidence and risk factors for skin cancer associated with allogeneic hematopoietic stem cell transplantation, we evaluated 1,974 adult allogeneic hematopoietic stem cell transplantation patients from Beth Israel Deaconess Medical Center and Dana-Farber Cancer Institute who received transplants between January 1995 and July 2013 for hematologic malignancy and survived at least 100 days. Median age was 51.1 years, and median follow-up time was 3 years. Overall, 119 patients had 221 skin cancers. The incidences of squamous cell carcinomas (incidence rate ratio = 9.8; 95% confidence interval = 7.7-12.3), basal cell carcinomas (incidence rate ratio = 2.5; 95% confidence interval = 1.9-3.2), and melanoma (standardized incidence ratio = 3.3; 95% confidence interval = 1.7-5.9) were elevated in our cohort. In multivariable models, risk factors for squamous cell carcinomas were increased age (P < 0.0001), chronic lymphocytic leukemia (P = 0.02), and chronic graft-versus-host disease (P = 0.0002). Risk factors for basal cell carcinomas were chronic lymphocytic leukemia (P = 0.003), reduced-intensity conditioning (P = 0.02), acute graft-versus-host disease (P = 0.03), and chronic graft-versus-host disease (P = 0.003). To our knowledge, previously unreported risk factors in this contemporary cohort include prior CLL for squamous cell carcinoma and basal cell carcinoma and reduced-intensity conditioning for basal cell carcinoma. This study also supports chronic graft-versus-host disease as a risk factor for nonmelanoma skin cancer, particularly squamous cell carcinoma.
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Affiliation(s)
- Peggy A Wu
- Beth Israel Deaconess Medical Center, Department of Dermatology, Boston Massachusetts, USA.
| | - Robert S Stern
- Beth Israel Deaconess Medical Center, Department of Dermatology, Boston Massachusetts, USA
| | - Victor Huang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin X Liu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Chen Amy Chen
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Dimitrios Tzachanis
- Blood and Marrow Transplant Program, University of California San Diego, La Jolla, California, USA
| | - Robin M Joyce
- Beth Israel Deaconess Medical Center, Section of Hematological Malignancies and Bone Marrow Transplantation, Harvard Medical School, Boston, Massachusetts, USA
| | - Roger B Davis
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Vincent T Ho
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Hampras SS, Locke FL, Chavez JC, Patel NS, Giuliano AR, Miller K, Gheit T, Tommasino M, Rollison DE. Prevalence of cutaneous viral infections in incident cutaneous squamous cell carcinoma detected among chronic lymphocytic leukemia and hematopoietic stem cell transplant patients. Leuk Lymphoma 2017; 59:911-917. [PMID: 28679298 DOI: 10.1080/10428194.2017.1342822] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The role of cutaneous viral infections in the development of non-melanoma skin cancer (NMSC), including cutaneous squamous cell carcinoma (SCC), among chronic lymphocytic leukemia (CLL) and blood and marrow transplant (BMT) patients is not established. CLL (n = 977) and BMT (n = 3587) patients treated at the Moffitt Cancer Center were included in a retrospective cohort study. Human papillomavirus (HPV) and human polyomavirus (HPyV) DNA were examined in a subset of incident SCC tumors. Five-year cumulative incidence of NMSC was 1.42% in both BMT (n = 31 NMSCs) and CLL (n = 18 NMSCs) cohorts. Of the nine SCC tumors examined from each cohort, 22.2% and 33.3% were positive for viral DNA in the transplant (HPV 65, MCV) and CLL (HPV 38, HPV 15, HPyV6) cohort, respectively. Enhanced skin cancer screening of BMT/CLL patients should be conducted to better capture incident NMSCs and examine the role of viral infections in these tumors.
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Affiliation(s)
- Shalaka S Hampras
- a Department of Cancer Epidemiology , Moffitt Cancer Center , Tampa , FL , USA
| | - Frederick L Locke
- b Department of Blood and Marrow Transplant and Cellular Immunotherapy , Moffitt Cancer Center , Tampa , FL , USA
| | - Julio C Chavez
- c Department of Malignant Hematology , Moffitt Cancer Center , Tampa , FL , USA
| | - Nishit S Patel
- d Department of Dermatology and Cutaneous Surgery, Morsani College of Medicine , University of South Florida , Tampa , FL , USA
| | - Anna R Giuliano
- a Department of Cancer Epidemiology , Moffitt Cancer Center , Tampa , FL , USA.,e Center for Infection Research in Cancer , Moffitt Cancer Center , Tampa , Florida , USA
| | - Kyle Miller
- f College of Agriculture and Life Sciences, University of Florida, Gainesville , Tampa , FL , USA
| | - Tarik Gheit
- g Infections and Cancer Biology Group , International Agency for Research on Cancer-World Health Organization , Lyon , France
| | - Massimo Tommasino
- g Infections and Cancer Biology Group , International Agency for Research on Cancer-World Health Organization , Lyon , France
| | - Dana E Rollison
- a Department of Cancer Epidemiology , Moffitt Cancer Center , Tampa , FL , USA.,e Center for Infection Research in Cancer , Moffitt Cancer Center , Tampa , Florida , USA
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Wojenski DJ, Bartoo GT, Merten JA, Dierkhising RA, Barajas MR, El-Azhary RA, Wilson JW, Plevak MF, Hogan WJ, Litzow MR, Patnaik MM, Wolf RC, Hashmi SK. Voriconazole exposure and the risk of cutaneous squamous cell carcinoma in allogeneic hematopoietic stem cell transplant patients. Transpl Infect Dis 2015; 17:250-8. [PMID: 25661996 DOI: 10.1111/tid.12367] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/21/2014] [Accepted: 01/18/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Voriconazole is a commonly used antifungal medication in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients. In solid organ transplantation, voriconazole use has been associated with the development of cutaneous squamous cell carcinoma (SCC). We sought to determine if voriconazole use was associated with SCC in patients undergoing allo-HSCT. METHODS We retrospectively reviewed consecutive adult patients who underwent allo-HSCT at Mayo Clinic from January 2007 through July 2012. Multivariable Cox models were created to assess the relationship of SCC with two time-dependent voriconazole exposure variables: (i) history of voriconazole exposure (yes/no), and (ii) cumulative days of voriconazole use. RESULTS In our cohort of 381 allo-HSCT patients, SCC developed in 26 of 312 patients exposed to voriconazole (25 post-voriconazole) and in 1 of 69 patients who received alternative antifungal agent(s). Cumulative incidence of SCC was estimated to be 19% at 5 years post allo-transplant. Cumulative days of voriconazole use was found to be a risk factor for SCC, and this relationship persisted in a multivariable model using previously identified risk factors as covariates (hazard ratio 1.859 for each 180 days of use, P < 0.001). CONCLUSION This is the first study, to our knowledge, to identify cumulative days of voriconazole use as a risk factor for SCC development following allo-HSCT, and may help guide appropriate antifungal use in this patient population.
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Affiliation(s)
- D J Wojenski
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
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Adhikari J, Sharma P, Bhatt VR. Risk of secondary solid malignancies after allogeneic hematopoietic stem cell transplantation and preventive strategies. Future Oncol 2015; 11:3175-85. [PMID: 26551415 DOI: 10.2217/fon.15.252] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The risk of secondary solid malignancies is increased after allogeneic hematopoietic stem cell transplantation (HSCT). The risk starts at about 10 years after HSCT and continues even 20 years later. The most common secondary malignancies include squamous cell carcinoma of skin, genitourinary tract and oral cavity; lung and breast cancers. The use of total body irradiation or conditioning chemotherapy, chronic graft-versus-host disease and duration since HSCT can influence the risk of secondary solid malignancies. Secondary solid malignancies are common causes of nonrelapse mortality in long-term survivors and may account for up to 10% of late deaths. Avoiding smoking, alcohol use and excess sun exposure may reduce the risk. Cancer prevention guidelines are largely consensus-driven and follow the recommendations for general population.
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Affiliation(s)
- Janak Adhikari
- Department of Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Priyadarshani Sharma
- Department of Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Vijaya Raj Bhatt
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Consensus for nonmelanoma skin cancer treatment: basal cell carcinoma, including a cost analysis of treatment methods. Dermatol Surg 2015; 41:550-71. [PMID: 25868035 DOI: 10.1097/dss.0000000000000296] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common cancer in the US population affecting approximately 2.8 million people per year. Basal cell carcinomas are usually slow-growing and rarely metastasize, but they do cause localized tissue destruction, compromised function, and cosmetic disfigurement. OBJECTIVE To provide clinicians with guidelines for the management of BCC based on evidence from a comprehensive literature review, and consensus among the authors. MATERIALS AND METHODS An extensive review of the medical literature was conducted to evaluate the optimal treatment methods for cutaneous BCC, taking into consideration cure rates, recurrence rates, aesthetic and functional outcomes, and cost-effectiveness of the procedures. RESULTS Surgical approaches provide the best outcomes for BCCs. Mohs micrographic surgery provides the highest cure rates while maximizing tissue preservation, maintenance of function, and cosmesis. CONCLUSION Mohs micrographic surgery is an efficient and cost-effective procedure and remains the treatment of choice for high-risk BCCs and for those in cosmetically sensitive locations. Nonsurgical modalities may be used for low-risk BCCs when surgery is contraindicated or impractical, but the cure rates are lower.
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von Bahr L, Blennow O, Alm J, Björklund A, Malmberg KJ, Mougiakakos D, Le Blanc A, Oefner PJ, Labopin M, Ljungman P, Le Blanc K. Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation. Bone Marrow Transplant 2015; 50:1217-23. [PMID: 26030049 DOI: 10.1038/bmt.2015.123] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/14/2015] [Accepted: 04/18/2015] [Indexed: 12/13/2022]
Abstract
Vitamin D has emerged as a central player in the immune system, with its deficiency being implicated in the pathogenesis of several autoimmune diseases, including chronic GvHD. This is a retrospective cohort analysis of 166 patients, who underwent allogeneic hematopoietic stem cell transplantation (HSCT) at the Karolinska University Hospital, evaluating GvHD, graft failure, infectious complications and survival after HSCT in relation to pre-transplantation vitamin D levels. Most of the patients were deficient in vitamin D before HSCT (median 42 nmol/L). In multivariate analysis, vitamin D level before HSCT was identified as a significant independent risk factor for development of cGvHD. The increased incidence of cGvHD was not coupled to better disease-free survival; instead there was a trend towards lower overall survival in the vitamin D-deficient patients. In addition, we found a significant correlation between vitamin D deficiency and incidence of CMV disease, with no case of CMV disease occurring in patients with sufficient levels of vitamin D before HSCT. Our results support a role of vitamin D in immune tolerance following HSCT. These findings could be highly relevant for the care of HSCT patients, and prospective, randomized studies on the effect of vitamin D supplementation are therefore needed.
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Affiliation(s)
- L von Bahr
- Department of Medicine, Hematology Centre, Karolinska University Hospital, Stockholm, Sweden.,Center for Hematology and Regenerative Medicine, Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - O Blennow
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Alm
- Center for Hematology and Regenerative Medicine, Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Björklund
- Department of Medicine, Hematology Centre, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - K-J Malmberg
- Department of Medicine, Hematology Centre, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,The KG Jebsen Center for Cancer Immunotherapy, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - D Mougiakakos
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - A Le Blanc
- Department of Medicine, Hematology Centre, Karolinska University Hospital, Stockholm, Sweden
| | - P J Oefner
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - M Labopin
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France
| | - P Ljungman
- Department of Medicine, Hematology Centre, Karolinska University Hospital, Stockholm, Sweden
| | - K Le Blanc
- Department of Medicine, Hematology Centre, Karolinska University Hospital, Stockholm, Sweden.,Center for Hematology and Regenerative Medicine, Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Gru AA, Lu D. Concurrent malignant melanoma and cutaneous involvement by classical Hodgkin lymphoma (CHL) in a 63 year-old man. Diagn Pathol 2013; 8:135. [PMID: 23938065 PMCID: PMC3765467 DOI: 10.1186/1746-1596-8-135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/21/2013] [Indexed: 12/26/2022] Open
Abstract
Abstract Classical Hodgkin lymphoma (CHL) is a lymphoproliferative disorder that has a bimodal age distribution, affecting young and elderly individuals, and is curable in more than 90% of patients. Here we report the coexistence of cutaneous CHL and malignant melanoma as the presentation of papules and a plaque, in an individual with remote history of systemic CHL. One of the biopsies showed a mononuclear cell infiltrate with Reed-Sternberg (RS) like cells that were positive for CD30 and CD15, but negative for CD45. A second concurrent biopsy showed an atypical melanocytic proliferation with significant pagetoid spreading and diffuse Melan-A staining. Based on morphology alone, it is almost impossible to distinguish CHL from other primary cutaneous lymphoproliferative disorders, such as CD30+ lymphoproliferative disorder (lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large-cell lymphoma), or even tumor stage mycosis fungoides when the epidermotropism is minimal. Additionally, bizarre melanocytic cells can also appear similar to RS cells. Our case illustrates the first case report of malignant melanoma and CHL in a patient presenting simultaneously. Virtual slides The virtual slide(s) for this article can be found here:
http://www.diagnosticpathology.diagnomx.eu/vs/8979757349937225
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Peuvrel L, Chiffoleau A, Quéreux G, Brocard A, Saint-Jean M, Batz A, Jolliet P, Dréno B. Melanoma and rituximab: an incidental association? Dermatology 2013; 226:274-8. [PMID: 23941917 DOI: 10.1159/000350681] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 03/11/2013] [Indexed: 11/19/2022] Open
Abstract
Rituximab is an anti-CD20 monoclonal antibody increasingly used in haematology and rheumatology, but also in internal medicine and dermatology. It has a good tolerance profile without known increased risk of cancer. We report a case of nodular melanoma with a 4.8 mm Breslow thickness that appeared after 2 years of rituximab in a 45-year-old patient with non-Hodgkin lymphoma. Fifteen additional rituximab-associated melanoma cases in 13 patients have been identified in the literature and in the EudraVigilance database. These patients were treated for various indications and had melanomas, often aggressive, initially diagnosed at a metastatic stage in 31% of cases. Our work raises the question of rituximab accountability in melanoma onset in these immunosuppressed patients. A dermatological monitoring seems necessary in patients treated with rituximab, especially in case of risk factors for melanoma. In case of individual melanoma history, the benefit/risk ratio of initiating rituximab therapy should be carefully assessed.
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Affiliation(s)
- L Peuvrel
- Department of Dermato-Cancerology, Nantes University Hospital, INSERM U892-CNRS U6299, CIC Biothérapie INSERM 0503, Nantes, France
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Shimoni A, Shem-Tov N, Chetrit A, Volchek Y, Tallis E, Avigdor A, Sadetzki S, Yerushalmi R, Nagler A. Secondary malignancies after allogeneic stem-cell transplantation in the era of reduced-intensity conditioning; the incidence is not reduced. Leukemia 2012; 27:829-35. [DOI: 10.1038/leu.2012.299] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Long-term disease-free survival after nonmyeloablative cyclophosphamide/fludarabine conditioning and related/unrelated allotransplantation for acute myeloid leukemia/myelodysplasia. Bone Marrow Transplant 2010; 45:1300-8. [DOI: 10.1038/bmt.2009.348] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
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 with 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 the risk increasing over time (P trend < .001); the risk reached 3-fold among patients followed for 15 years or more after transplantation. 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 nonirradiated patients, while the comparable risk for older patients was 1.1 (P interaction < .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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