Blood or marrow transplant survivors at high risk for malignant neoplasms in the GI tract
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Survivors of blood or marrow transplants exhibited an increased risk for developing subsequent malignant neoplasms in the gastrointestinal tract, according to results of a cohort study published in JAMA Oncology.
The risk varied based on cancer type and therapeutic exposures, researchers found.
“Blood or marrow transplant recipients were at a 3.6-fold higher risk for developing an SMN in the [gastrointestinal tract] compared with the general population,” Andrew McDonald, MD, MS, assistant professor and director of the radiation oncology residency program at The University of Alabama at Birmingham School of Medicine, and colleagues wrote.
Background and methodology
The number of long-term blood or marrow transplant survivors in the United States is expected to exceed 500,000 by 2030. This population is at an increased risk for subsequent malignant neoplasms (SMNs), which are the leading cause of nonrelapse mortality among long-term survivors.
Cancers of the GI system are of particular interest due to their often aggressive clinical behavior, researchers wrote.
McDonald and colleagues utilized the Blood or Marrow Transplant Survivor Study to identify demographic, clinical and therapeutic factors associated with risk for SMNs in the GI tract among transplant survivors.
The study cohort included 6,710 individuals (median age, 46 years; range, 0-78; 58.4% male; 73.2% white) who survived at least 2 years after autologous (51.3%) or allogeneic (48.7%) transplants performed from 1974 to 2014 at City of Hope, University of Minnesota or The University of Alabama at Birmingham.
Participants self-reported SMNs in the GI tract, later confirmed via pathology reports and/or medical records, and via death records for deceased patients.
The investigators used standardized incidence ratios to determine excess risk for SMNs in the GI tract compared with that of the general populations.
Results
Among the patients, 148 developed SMNs in the GI tract after 62,479 person-years of follow-up. SIRs for specific SMNs ranged from 2.1 (95% CI, 1.6-2.8) for colorectal cancer to 7.8 (95% CI, 5-11.6) for esophageal cancer.
Researchers identified an association of exposure to cytarabine for conditioning with subsequent colorectal cancer (subdistribution HR [SHR] = 3.1; 95% CI, 1.5-6.6).
Compared with autologous transplant recipients, allogeneic transplant recipients with chronic graft-versus-host disease had an increased risk for esophageal cancer (SHR = 9.9; 95% CI, 3.2-30.5). Anthracycline exposure prior to transplant (SHR = 5.4; 95% CI, 1.3-23.4) and conditioning with etoposide (SHR = 2; 95% CI, 1.1-3.5) appeared associated with increased risk for liver cancer compared with no exposure to the agents.
Next steps
Additional screening requirements should be established for the growing number of transplant survivors in order to best evaluate long-term risk, according to researchers.
“The findings of this cohort study are relevant for oncologists and nononcologists who care for the growing number of survivors of transplant,” researchers wrote. “Awareness of subgroups of [transplant survivors] at high risk for specific types of SMNs in the GI tract may influence recommendations regarding modifiable risk factors, as well as individualized screening.”
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