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Post-transplant Events

Second cancer risk in adults receiving autologous haematopoietic SCT for cancer: a population-based cohort study

Abstract

Population-based evidence on second cancer risk following autologous haematopoietic SCT (HCT) is lacking. We quantified second cancer risk for a national, population-based cohort of adult Australians receiving autologous HCT for cancer and notified to the Australasian Bone Marrow Transplant Recipient Registry 1992–2007 (n=7765). Cancer diagnoses and deaths were ascertained by linkage with the Australian Cancer Database and National Death Index. Standardized incidence ratios (SIRs) were calculated and Cox regression models were used to estimate within-cohort risk factors treating death as a competing risk. During a median 2.5 years follow-up, second cancer risk was modestly increased compared with the general population (SIR 1.4, 95% confidence interval 1.2–1.6); significantly elevated risk was also observed for AML/myelodysplastic syndrome (SIR=20.6), melanoma (SIR=2.6) and non-Hodgkin lymphoma (SIR=3.3). Recipients at elevated risk of any second cancer included males, and those transplanted at a younger age, in an earlier HCT era, or for lymphoma or testicular cancer. Male sex, older age (>45 years) and history of relapse after HCT predicted melanoma risk. Transplantation for Hodgkin lymphoma and older age were associated with lung cancer risk. Second malignancies are an important late effect and these results inform and emphasize the need for cancer surveillance in autologous HCT survivors.

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Acknowledgements

This work was supported by the National Health and Medical Research Council (APP568775); the Arrow Bone Marrow Transplant Foundation Australia; and support to the ABMTRR from the Commonwealth Department of Health and Ageing. These agencies had no role in the design of the study, collection and analysis of data, or decision to publish. We thank the staff of the hospital SCT units, the state and territory cancer registries and health departments for the use of their data, and the Australian Institute of Health and Welfare for conducting the data linkage. The ABMTRR is grateful to the BMT Network NSW, the Arrow Bone Marrow Transplant Foundation, St Vincent’s Hospital Darlinghurst and the Australian Bone Marrow Donor Registry for their support.

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Correspondence to C M Vajdic.

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L Ashton, R Le Marsney (Children's Cancer Institute Australia, New South Wales); A Dodds, J Tan, I Bilmon (St Vincent's Hospital, New South Wales); L Wilcox, I Nivison-Smith, D Aarons, S Tran (ABMTRR); C Vajdic (University of New South Wales, New South Wales); J Gibson, A Johnston (Royal Prince Alfred Hospital, New South Wales); M Greenwood, M Forbes (Royal North Shore Hospital, New South Wales); M Hertzberg, G Huang (Westmead Hospital, New South Wales); A Spencer, J Muirhead (Alfred Hospital, Victoria); J Szer, K Mason, (Royal Melbourne Hospital, Victoria); I Lewis, C To (Royal Adelaide Hospital, South Australia); S Durrant, R Western (Royal Brisbane and Women's Hospital, Queensland); P Cannell, S Buffery (Royal Perth Hospital, Western Australia); T O'Brien, C Oswald, A Nelson (Sydney Children's Hospital, New South Wales); P Shaw, L Pearson (Children's Hospital at Westmead, New South Wales); K Tiedemann, M Scoyne (Royal Children's Hospital Melbourne, Victoria); C Fraser, J Seljak, (Royal Children's Hospital Brisbane, Queensland); C Cole, K Rowland, H Gough, (Princess Margaret Hospital for Children, Western Australia); H Tapp, N Green (Women and Children's Hospital, South Australia). Data collectors: A Moa, J McRae and M Jenkins (Children's Cancer Institute Australia, New South Wales); J Hicks (Royal Melbourne Hospital, Victoria); K Chaplin (Royal Adelaide Hospital, South Australia).

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Bilmon, I., Ashton, L., Le Marsney, R. et al. Second cancer risk in adults receiving autologous haematopoietic SCT for cancer: a population-based cohort study. Bone Marrow Transplant 49, 691–698 (2014). https://doi.org/10.1038/bmt.2014.13

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