CANCER OF THE ESOPHAGUS FOLLOWING ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR ACUTE-LEUKEMIA

The successful development of allogeneic bone marrow transplantation ( BMT) has markedly improved the treatment results for acute leukemia an d other hematologic diseases. However, significant complications are a ssociated with this procedure including the development of chronic gra ft versus host disease (GVHD). Treatment for this condition requires c hronic immunosuppression which can lead to the development of second c ancers. It is well known that immunosuppression is associated with a v ariety of tumors, most commonly lymphoma. The development of solid tum ors appears to be less common but follow-up studies of patients treate d for Hodgkin's disease demonstrate a rising incidence of solid tumor development after a delay of 5 to 10 years. We describe a patient rece ntly treated for a squamous cell carcinoma of the esophagus which deve loped 5 years after an allogeneic BMT for acute myelogenous leukemia ( AML). The patient had been treated with immunosuppressants for chronic GVHD. The clinical course is described and the literature is reviewed regarding recent experience with the development of solid tumors foll owing allogeneic BMT. The majority of second tumors following BMT are lymphomas and leukemias. Secondary solid tumors are less common, but t he incidence appears to increase over time. Squamous carcinomas are mo st common and a preparative regimen combining radiation and chemothera py may increase risk. Careful long-term follow-up of BMT is essential in order to detect second tumors at an early stage.