造血幹細胞移植後の二次性悪性腫瘍

抄録

Secondary malignancies are an important late complication after hematopoietic stem cell transplantation. Several studies have reported that survivors of HSCT have a 2―3-fold increased risk of developing new solid cancers compared with an age‐, sex‐, region‐, and calendar-year-adjusted population. We analyzed the incidence of, risk compared with that in the general population, and risk factors for secondary solid cancers among 17,545 adult recipients of a first allogeneic stem cell transplantation between 1990 and 2007 in Japan. A total of 269 secondary solid cancers were identified. The cumulative incidence was 0.7% at 5 years and 1.7% at 10 years after transplant. The risk was significantly higher than that in the general population (standard incidence ratio [SIR]＝1). Risk was higher for oral cancer (SIR=15.7), esophageal cancer (SIR=8.5), colon cancer (SIR=1.9), skin cancer (SIR=7.2), and brain/nervous system cancer (SIR=4.1). The risk of developing oral, esophageal, or skin cancer was higher at all times after 1-year posttransplant. Extensive-type chronic graft-versus-host disease (GVHD) was a significant risk factor for the development of oral (RR=2.9, p＜0.001) and esophageal (RR=5.3, p＜0.001) cancers. Recipients of allogeneic HSCT had a significantly higher risk of developing secondary solid cancers than the general population. Lifelong screening for high-risk organ sites, especially oral and esophageal cancers, is important for recipients with active, or a history of, chronic GVHD.