2ND NEOPLASMS FOLLOWING HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS STEM-CELL TRANSPLANTATION FOR MALIGNANT-LYMPHOMAS - A REPORT OF 6 CASES IN A COHORT OF 171 PATIENTS FROM A SINGLE INSTITUTION

High dose chemotherapy with autologous stem cell transplantation (ASCT ) is increasingly used in the treatment of patients with lymphoma. As previously shown with conventional treatments, second neoplasms are em erging as a long term complication of the procedure. In this study, we investigate the incidence of second neoplasm in a cohort of 171 patie nts treated with BEAM or BEAC regimens for Hodgkin's disease (n = 62) and non-Hodgkin's lymphomas (n = 109) followed up for a median of 52 m onths post ASCT. Six patients developed six second malignancies 12 to 105 months after ASCT: fibrolamellar carcinoma of the liver, malignant fibrous histiocytoma, pancreatic carcinoma, squamous cell carcinoma o f the lung, invasive carcinoma of the vulva and acute myelogenous leuk emia. The cumulative actuarial risk for developing second malignancy i s 16.7 % (95% confidence interval: 5.9-39.3%) 13 years after transplan t. The age-adjusted incidence of cancer in the study group is 4.1 time s higher than that of primary cancer in the general population. These data confirm that ASCT recipients are at increased risk of later malig nancies. This complication adds significant morbidity and mortality to the transplant process and therefore, needs to be taken into account in long term evaluation of new strategies which involve early intensif ication in the treatment of lymphomas.