2023 Volume 12 Issue 2 Pages 103-109
Subsequent malignant neoplasms are the most common late complication after hematopoietic cell transplantation (HCT), and are classified into post-transplant lymphoproliferative disorder (PTLD), myeloid neoplasms following HCT, and subsequent solid cancers. PTLD usually occurs within 1 year after HCT, with incidences of 0.1% after autologous HCT and 0.8% after allogenic HCT. T-cell depletion, aplastic anemia, unrelated donor, HLA mismatch, and cord blood graft are associated with PTLD development. Myeloid neoplasms usually occur within a few years after HCT, with incidences of 2.3% after autologous HCT and 0.4% after allogenic HCT. One-third of cases exhibit chromosome 5 or 7 abnormalities and have dismal survival. Subsequent solid cancers start to occur a few years after HCT, with no plateau. The incidence is 4% at 20 years after allogeneic HCT. Oropharyngeal cancer, esophageal cancer, and colorectal cancer are most common in Japanese patients, and the standardized incidence ratios of these cancers are 7 to 16-fold higher than in the general population. Most subsequent solid cancers occur at younger ages than in the general population, and well-established risk factors are chronic graft-versus-host disease, long-term use of immunosuppressive medications, prior radiation therapy, and younger or older age at HCT.
