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Allogeneic HSCT recipients face increased risk for skin cancer
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Recipients of allogeneic hematopoietic stem cell transplantation faced an increased risk for basal cell carcinoma, squamous cell carcinoma and malignant melanoma, according to the results of a population-based cohort study.
Further, the receipt of total body irradiation served as a major determining risk factor for basal cell carcinoma, according to the researchers.
“Immunosuppressed patients are at increased risk for developing cutaneous cancer,” Silje Haukali Omland, MD, of the department of dermatovenerology at Copenhagen University Hospital, and colleagues wrote. “This is well known for solid-organ transplant recipients undergoing lifelong immunosuppressive therapy, who are at a highly increased risk for nonmelanoma skin cancer.”
The risk for skin cancer among patients undergoing HSCT has not been widely studied, according to study background.
Omland and colleagues sought to determine the risk for cutaneous cancer in recipients of HSCT, compared with the risk for people undergoing renal transplant and individuals who did not undergo transplantation.
The researchers used the Danish National Hospital Register to identify 3,302 patients who underwent HSCT (allogeneic, n = 1,007; autologous, n = 2,295) between 1999 and 2014, as well as 4,789 recipients of renal transplants between 1976 and 2014. For each group, the researchers included 10 age- and sex-matched non-transplanted people from the background population.
The researchers calculated person-years at risk from the time of study inclusion until first cutaneous cancer.
Time to first appearance of basal cell carcinoma, squamous cell carcinoma and malignant melanoma — as well as the comparative risk elements for cutaneous cancers in HSCT and renal transplant recipients — served as the primary endpoints.
Cutaneous cancer developed in 2.6% of allogeneic HSCT recipients and in 0.9% of their matched background population; 2% of autologous HSCT recipients and 3.6% of their background population; and in 14% of renal transplant recipients and 5.8% of their background population.
The researchers found that compared with the background population, allogeneic HSCT recipients faced an increased risk for basal cell carcinoma (HR = 3.1; 95% CI, 1.9-5.2), squamous cell carcinoma (HR = 18.3; 95% CI, 4.1-81.8) and malignant melanoma (HR = 5.5; 95% CI, 1.7-17.7).
Further, allogeneic HSCT recipients had a threefold increased risk for malignant melanoma compared with renal transplant recipients (HR = 4; 95% CI, 1.3-12.1).
The risk for basal cell carcinoma after allogeneic HSCT occurred exclusively in patients conditioned with total-body irradiation (HR = 3.9; 95% CI, 2.6-6.8). Although allogeneic HSCT and renal transplant recipients had a similar risk for basal cell carcinoma, the risk for squamous cell carcinoma was highest among renal transplant recipients (HR = 34.3; 95% CI, 28-41.9).
Autologous HSCT recipients did not exhibit an increased risk for skin cancer.
“In Denmark, solid-organ transplant recipients are regularly screened for skin cancer at outpatient dermatology clinics,” Omland and colleagues wrote. “Conversely, allogeneic HSCT recipients are not systematically examined for cutaneous cancer. In light of our findings, future efforts in secondary prevention following allogeneic HSCT should be intensified and particularly aimed at total-body irradiation-exposed individuals. Furthermore, studies examining prognosis of skin cancer in HSCT recipients are needed.” – by Cameron Kelsall
Disclosure: One study researcher reports consultant roles with Abbvie, Janssen, Lilly, Merck Sharp & Dohme Corp, Novartis and Pfizer. Omland and the other researchers report no relevant financial disclosures.
Perspective
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Anthony F. Santoro, MD
Omland and colleagues report a large population-based study from Denmark analyzing rates of skin cancer development in hematopoietic stem cell and renal transplant patients. The results confirm the need for routine on-going skin cancer evaluations in transplant patients.
The study revealed an overall increased risk for all skin cancers in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and renal transplantation compared with the general population, whereas there was no statistically significant difference in cutaneous cancer rates between autologous HSCT patients and the general population. The allogeneic HSCT recipients had an increased risk for melanoma compared to the renal transplant patients, whereas the renal patients had a higher risk for developing squamous cell cancers. The authors theorize the difference in susceptibility to certain cancers affecting the two different transplant groups may be secondary to exposure to radiotherapy and duration of immunosuppressive drug regimens. The findings highlight the need for long-term dermatologic screenings for both groups of transplant patients.
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