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Increasing incidence of late second malignancies after conditioning with cyclophosphamide and total-body irradiation and autologous bone marrow transplantation for non-Hodgkin's lymphoma.
J Clin Oncol. 2005 Apr 01; 23(10):2208-14.JC

Abstract

PURPOSE

Although the risk of myelodysplastic syndrome (MDS) has been well-described following autologous bone marrow transplantation (ABMT), the risk of solid tumors has been poorly characterized. We report the incidence and outcome of solid tumors at 10-year follow-up in a large cohort of uniformly treated patients who underwent ABMT for non-Hodgkin's lymphoma (NHL).

PATIENTS AND METHODS

Between 1982 and 1997, 605 patients underwent ABMT for B-cell NHL, with uniform conditioning with cyclophosphamide and total-body irradiation followed by reinfusion of autologous bone marrow purged with anti-B-cell monoclonal antibodies. Current information on relapse of disease and second malignancies was obtained via an institutional review board-approved questionnaire sent to the referring oncologists.

RESULTS

Forty-two solid tumors, six non-MDS hematologic malignancies, 39 nonmelanoma skin cancers, and 68 cases of MDS/acute myelogenous leukemia (AML) were observed at a median follow-up of 9.5 years. A cumulative incidence model using death as a competing risk found that the 10-year incidence of second malignancy is 21%, with 10.0% non-MDS malignancies. The projected incidence of all malignancies at 15 years is 29%. The principal risk factor for second malignancy is increased age at ABMT (P = .0002). In the entire cohort, 9.6% of patients have died of second malignancy.

CONCLUSION

Lengthy follow-up demonstrates a significant incidence of second malignancies after ABMT for NHL. Although the incidence of MDS/AML starts to plateau, the incidence of solid tumors continues to rise. Second malignancies are responsible for a significant fraction of overall mortality following ABMT.

Authors+Show Affiliations

Department of Medical Oncology, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15753460

Citation

Brown, Jennifer R., et al. "Increasing Incidence of Late Second Malignancies After Conditioning With Cyclophosphamide and Total-body Irradiation and Autologous Bone Marrow Transplantation for non-Hodgkin's Lymphoma." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 23, no. 10, 2005, pp. 2208-14.
Brown JR, Yeckes H, Friedberg JW, et al. Increasing incidence of late second malignancies after conditioning with cyclophosphamide and total-body irradiation and autologous bone marrow transplantation for non-Hodgkin's lymphoma. J Clin Oncol. 2005;23(10):2208-14.
Brown, J. R., Yeckes, H., Friedberg, J. W., Neuberg, D., Kim, H., Nadler, L. M., & Freedman, A. S. (2005). Increasing incidence of late second malignancies after conditioning with cyclophosphamide and total-body irradiation and autologous bone marrow transplantation for non-Hodgkin's lymphoma. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 23(10), 2208-14.
Brown JR, et al. Increasing Incidence of Late Second Malignancies After Conditioning With Cyclophosphamide and Total-body Irradiation and Autologous Bone Marrow Transplantation for non-Hodgkin's Lymphoma. J Clin Oncol. 2005 Apr 1;23(10):2208-14. PubMed PMID: 15753460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increasing incidence of late second malignancies after conditioning with cyclophosphamide and total-body irradiation and autologous bone marrow transplantation for non-Hodgkin's lymphoma. AU - Brown,Jennifer R, AU - Yeckes,Heather, AU - Friedberg,Jonathan W, AU - Neuberg,Donna, AU - Kim,Helen, AU - Nadler,Lee M, AU - Freedman,Arnold S, Y1 - 2005/03/07/ PY - 2005/3/9/pubmed PY - 2005/4/22/medline PY - 2005/3/9/entrez SP - 2208 EP - 14 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 23 IS - 10 N2 - PURPOSE: Although the risk of myelodysplastic syndrome (MDS) has been well-described following autologous bone marrow transplantation (ABMT), the risk of solid tumors has been poorly characterized. We report the incidence and outcome of solid tumors at 10-year follow-up in a large cohort of uniformly treated patients who underwent ABMT for non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: Between 1982 and 1997, 605 patients underwent ABMT for B-cell NHL, with uniform conditioning with cyclophosphamide and total-body irradiation followed by reinfusion of autologous bone marrow purged with anti-B-cell monoclonal antibodies. Current information on relapse of disease and second malignancies was obtained via an institutional review board-approved questionnaire sent to the referring oncologists. RESULTS: Forty-two solid tumors, six non-MDS hematologic malignancies, 39 nonmelanoma skin cancers, and 68 cases of MDS/acute myelogenous leukemia (AML) were observed at a median follow-up of 9.5 years. A cumulative incidence model using death as a competing risk found that the 10-year incidence of second malignancy is 21%, with 10.0% non-MDS malignancies. The projected incidence of all malignancies at 15 years is 29%. The principal risk factor for second malignancy is increased age at ABMT (P = .0002). In the entire cohort, 9.6% of patients have died of second malignancy. CONCLUSION: Lengthy follow-up demonstrates a significant incidence of second malignancies after ABMT for NHL. Although the incidence of MDS/AML starts to plateau, the incidence of solid tumors continues to rise. Second malignancies are responsible for a significant fraction of overall mortality following ABMT. SN - 0732-183X UR - https://www.unboundmedicine.com/medline/citation/15753460/Increasing_incidence_of_late_second_malignancies_after_conditioning_with_cyclophosphamide_and_total_body_irradiation_and_autologous_bone_marrow_transplantation_for_non_Hodgkin's_lymphoma_ L2 - https://ascopubs.org/doi/10.1200/JCO.2005.05.158?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -