Second solid cancers after allogeneic hematopoietic cell transplantation using reduced-intensity conditioning

Olle Ringdén, Ruta Brazauskas, Zhiwei Wang, Ibrahim Ahmed, Yoshiko Atsuta, David Buchbinder, Linda J. Burns, Jean Yves Cahn, Christine Duncan, Gregory A. Hale, Joerg Halter, Robert J. Hayashi, Jack W. Hsu, David A. Jacobsohn, Rammurti T. Kamble, Naynesh R. Kamani, Kimberly A. Kasow, Nandita Khera, Hillard M. Lazarus, Alison W. LorenDavid I. Marks, Kasiani C. Myers, Muthalagu Ramanathan, Wael Saber, Bipin N. Savani, Harry C. Schouten, Gérard Socie, Mohamed L. Sorror, Amir Steinberg, Uday Popat, John R. Wingard, Jonas Mattsson, Navneet S. Majhail

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


We examined risk of second solid cancers after allogeneic hematopoietic cell transplantation (AHCT) using reduced-intensity/nonmyeloablative conditioning (RIC/NMC). RIC/NMC recipients with leukemia/myelodysplastic syndrome (MDS) (n=2833) and lymphoma (n=1436) between 1995 and 2006 were included. In addition, RIC/NMC recipients 40 to 60years of age (n=2138) were compared with patients of the same age receiving myeloablative conditioning (MAC, n=6428). The cumulative incidence of solid cancers was 3.35% at 10years. There was no increase in overall cancer risk compared with the general population (leukemia/MDS: standardized incidence ratio [SIR] .99, P=1.00; lymphoma: SIR .92, P=75). However, risks were significantly increased in leukemia/MDS patients for cancers of lip (SIR 14.28), tonsil (SIR 8.66), oropharynx (SIR 46.70), bone (SIR 23.53), soft tissue (SIR 12.92), and vulva (SIR 18.55) and skin melanoma (SIR 3.04). Lymphoma patients had significantly higher risks of oropharyngeal cancer (SIR 67.35) and skin melanoma (SIR 3.52). Among RIC/NMC recipients, age >50 years was the only independent risk factor for solid cancers (hazard ratio [HR] 3.02, P<.001). Among patients ages 40 to 60years, when adjusted for other factors, there was no difference in cancer risks between RIC/NMC and MAC in leukemia/MDS patients (HR .98, P=905). In lymphoma patients, risks were lower after RIC/NMC (HR .51, P=047). In conclusion, the overall risks of second solid cancers in RIC/NMC recipients are similar to the general population, although there is an increased risk of cancer at some sites. Studies with longer follow-up are needed to realize the complete risks of solid cancers after RIC/NMC AHCT.

Original languageEnglish
Pages (from-to)1777-1784
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Issue number11
StatePublished - Nov 1 2014


  • Hematopoietic cell transplantation
  • Nonmyeloablative conditioning
  • Reduced-intensity conditioning
  • Second cancers
  • Solid tumors


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