Over a quarter of stem cell transplant survivors develop cutaneous malignant neoplasms
Key takeaways:
- Survivors of blood or marrow transplant had increased risk for subsequent cutaneous malignant neoplasms.
- Basal cell carcinoma occurred more frequently than squamous cell carcinoma or melanoma.
More than one-quarter of blood or marrow transplant survivors developed cutaneous malignant neoplasms, according to study results.
Researchers identified several risk factors, including older age, development of chronic graft-versus-host disease and receipt of total body irradiation.
“This study demonstrated that certain people who undergo blood or marrow transplant are at greater risk for subsequent skin cancers based on their individual characteristics and the treatments they have received,” Kristy K. Broman, MD, MPH, assistant professor in the division of surgical oncology at The University of Alabama at Birmingham, told Healio. “These individuals should be followed more closely with routine exams by a dermatologist in order to detect and treat skin cancers at an early stage.”
Cutaneous malignant neoplasms are the most common subsequent neoplasm diagnosed among blood or marrow transplant survivors. Prior research into this topic has been limited by small sample sizes, limited follow-up or exclusion of certain cancer types, according to study background.
Broman and colleagues conducted a retrospective cohort study to identify potential risk factors for subsequent malignant neoplasms among transplant survivors.
The analysis included 3,880 bone or marrow transplant survivors (median age at transplant, 44 years; 55.8% men; 74.7% non-Hispanic white) who participated in the BMT Survivor Study. All members of the cohort underwent transplant between 1974 and 2014 at one of three institutions — City of Hope, University of Minnesota or The University of Alabama at Birmingham — and survived at least 2 years after transplant.
The study also included a comparison cohort comprised of transplant survivors’ siblings.
Researchers assessed incidence of any cutaneous malignant neoplasm — including basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma — after transplant.
After median follow-up of 9.5 years (range, 2-46), 605 transplant survivors developed 778 cutaneous neoplasms (BCC, n = 321; SCC, n = 231; melanoma, n = 78; unknown type, n = 148).
Researchers calculated 30-year cumulative incidence of any cutaneous malignant neoplasm of 27.4%, with higher incidence of BCC (18%) than SCC (9.8%) or melanoma (3.7%).
Investigators also calculated significantly higher 70-year cumulative probabilities among survivors than siblings for BCC (18.1% vs. 8.2%), SCC (14.7% vs. 4.2%) and melanoma (4.2% vs. 2.4%).
Risk factors for subsequent cutaneous malignant neoplasms among blood or marrow transplant survivors included being aged 50 years or older (BCC: subdistribution HR = 1.76; 95% CI, 1.36-2.29; SCC: subdistribution HR = 3.37; 95% CI, 2.41-4.72), male sex (BCC: subdistribution HR = 1.39; 95% CI, 1.1-1.75; SCC: subdistribution HR = 1.85; 95% CI, 1.39-2.45), pre-transplant monoclonal antibody exposure (BCC: subdistribution HR, 1.71; 95% CI, 1.27-2.31), developing chronic GVHD after allogeneic transplant (BCC: subdistribution HR = 1.48; 95% CI, 1.06-2.08; SCC: subdistribution HR = 2.61; 95% CI, 1.68-4.04) and post-transplant immunosuppression (BCC: subdistribution HR = 1.63; 95% CI, 1.24-2.14; SCC: subdistribution HR = 1.48; 95% CI, 1.09-2.02; melanoma: subdistribution HR = 1.9; 95% CI, 1.16-3.12).
Risks also varied based on transplant site, with elevated rates among those treated at City of Hope (BCC: subdistribution HR = 3.55; 95% CI, 2.58-4.89; SCC: subdistribution HR = 3.57; 95% CI, 2.34-5.47) or The University of Alabama at Birmingham (BCC: subdistribution HR, 2.35; 95%CI, 1.35-4.23; SCC: subdistribution HR, 2.63; 95% CI, 1.36-5.08).
Race or ethnicity other than non-Hispanic white appeared to be protective for BCC (Black: no cases; Hispanic: subdistribution HR = 0.27; 95% CI, 0.16-0.44; other race and multiracial: subdistribution HR= 0.26; 95% CI, 0.14-0.5) and SCC (Black: subdistribution HR = 0.17; 95% CI, 0.04-0.67; Hispanic: subdistribution HR = 0.28; 95% CI, 0.16-0.5; other race and multiracial: subdistribution HR = 0.13; 95% CI, 0.05-0.37).
Total body irradiation appeared associated with BCC risk among patients younger than 50 years at time of transplant (subdistribution HR = 1.92; 95% CI, 1.27-2.92).
Researchers acknowledged study limitations, including use of survey-based self-report for case identification and patients with an unknown skin cancer type not being included in the individual models.
“We are developing a predictive model and online risk calculator that patients and providers can use to understand their risk for subsequent skin cancer,” Broman told Healio.
For more information:
Kristy K. Broman, MD, MPH, can be reached at kristybroman@uabmc.edu.
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