Solid cancers after bone marrow transplantation

Purpose: To evaluate the incidence and associated risk factors of solid can cers after bone marrow transplantation (BMT). Patients and Methods: We analyled 2,129 patients who had undergone BMT for hematologic malignancies at the City of Hope National Medical Center betwee n 1976 and 1998. A retrospective cohort and nested case-control study desig n were used to evaluate the role of pretransplantation therapeutic exposure s and transplant conditioning regimens. Results: Twenty-nine patients developed solid cancers after BMT, which repr esents a two-fold increase in risk compared with a comparable normal popula tion. The estimated cumulative probability (+/- SE) for development of a so lid cancer was 6.1% +/- 1.6% at 10 years. The risk was significantly elevat ed for liver cancer (standardized incidence ratio [SIR], 27.7; 95% confiden ce interval [CI], 1.9 to 57.3), cancer of the oral cavity [SIR, 17.4; 95% C I, 6.3 to 34.1), and cervical cancer (SIR, 13.3; 95% CI, 3.5 to 29.6). Each of the two patients with liver cancer had a history of chronic hepatitis C infection. All six patients with squamous cell carcinoma of the skin had c hronic graft-versus-host disease. The risk was significantly higher for sur vivors who were younger than 34 years of age at time of BMT (SIR, 5.3; 95% CI, 2.7 to 8.6). Cancers of the thyroid gland, liver, and oral cavity occur red primarily among patients who received total-body irradiation. Conclusion: The risk of radiation-associated solid tumor development after BMT is likely to increase with longer follow-up. This underscores the impor tance of close monitoring of patients who undergo BMT. J Clin Oncol 19:464- 471. (C) 2001 by American Society of Clinical Oncology.