Risk factors for second solid cancers, according to time since transplantantion and type of solid cancer, among ≥ 1 year survivors of HCT
| Variable . | All solid cancers . | Non-SCC cancers . | SCC cancers . | ||||||
|---|---|---|---|---|---|---|---|---|---|
| No. cases . | RR . | 95% CI . | No. cases . | RR . | 95% CI . | No. cases . | RR . | 95% CI . | |
| General risk factors, ≥ 1-y survivors | n = 165 cases | n = 110 cases | n = 55 cases | ||||||
| TBI | 125 | 1.75† | 1.06-3.00 | 93 | 2.29† | 1.18-4.88 | 32 | 1.11 | 0.51-2.53 |
| LFI, no TBI | 9 | 2.95† | 1.13-7.35 | 4 | 3.94 | 0.92-14.77 | 5 | 2.24 | 0.62-7.95 |
| Chronic GVHD* | 56 | 1.55† | 1.10-2.16 | 21 | 0.70 | 0.41-1.12 | 35 | 5.04† | 2.90-9.00 |
| Risk factors by time after HCT | |||||||||
| 1-4 years after HCT | n = 65 cases | n = 48 cases | n = 17 cases | ||||||
| TBI | 47 | 1.37 | 0.75-2.66 | 37 | 1.63 | 0.78-3.81 | 10 | 0.96 | 0.33-3.09 |
| LFI, no TBI | 2 | 2.08 | 0.25-12.40 | 1 | 1.38 | 0.06-11.91 | 1 | 6.52 | 0.13-150 |
| Chronic GVHD* | 25 | 1.81† | 1.06-3.03 | 13 | 1.06 | 0.52-2.01 | 12 | 6.79† | 2.44-21.78 |
| ≥ 5 y after HCT | n = 100 cases | n = 62 cases | n = 38 cases | ||||||
| TBI | 78 | 2.74† | 1.17-6.82 | 56 | 6.33† | 1.58-35.52 | 22 | 1.33 | 0.43-4.33 |
| LFI, no TBI | 7 | 3.80† | 1.24-11.57 | 3 | 11.14† | 1.62-76.57 | 4 | 2.17 | 0.52-8.53 |
| Chronic GVHD* | 31 | 1.38 | 0.87-2.12 | 8 | 0.45† | 0.20-0.91 | 23 | 4.38† | 2.26-8.5.72 |
| Variable . | All solid cancers . | Non-SCC cancers . | SCC cancers . | ||||||
|---|---|---|---|---|---|---|---|---|---|
| No. cases . | RR . | 95% CI . | No. cases . | RR . | 95% CI . | No. cases . | RR . | 95% CI . | |
| General risk factors, ≥ 1-y survivors | n = 165 cases | n = 110 cases | n = 55 cases | ||||||
| TBI | 125 | 1.75† | 1.06-3.00 | 93 | 2.29† | 1.18-4.88 | 32 | 1.11 | 0.51-2.53 |
| LFI, no TBI | 9 | 2.95† | 1.13-7.35 | 4 | 3.94 | 0.92-14.77 | 5 | 2.24 | 0.62-7.95 |
| Chronic GVHD* | 56 | 1.55† | 1.10-2.16 | 21 | 0.70 | 0.41-1.12 | 35 | 5.04† | 2.90-9.00 |
| Risk factors by time after HCT | |||||||||
| 1-4 years after HCT | n = 65 cases | n = 48 cases | n = 17 cases | ||||||
| TBI | 47 | 1.37 | 0.75-2.66 | 37 | 1.63 | 0.78-3.81 | 10 | 0.96 | 0.33-3.09 |
| LFI, no TBI | 2 | 2.08 | 0.25-12.40 | 1 | 1.38 | 0.06-11.91 | 1 | 6.52 | 0.13-150 |
| Chronic GVHD* | 25 | 1.81† | 1.06-3.03 | 13 | 1.06 | 0.52-2.01 | 12 | 6.79† | 2.44-21.78 |
| ≥ 5 y after HCT | n = 100 cases | n = 62 cases | n = 38 cases | ||||||
| TBI | 78 | 2.74† | 1.17-6.82 | 56 | 6.33† | 1.58-35.52 | 22 | 1.33 | 0.43-4.33 |
| LFI, no TBI | 7 | 3.80† | 1.24-11.57 | 3 | 11.14† | 1.62-76.57 | 4 | 2.17 | 0.52-8.53 |
| Chronic GVHD* | 31 | 1.38 | 0.87-2.12 | 8 | 0.45† | 0.20-0.91 | 23 | 4.38† | 2.26-8.5.72 |
Multivariate Poisson regression models were based on 165 solid cancers, including 18 invasive SCCs of the skin and 13 nonskin carcinomas in situ; analyses were stratified by registry (FHCRC, CIBMTR), age (<10, 20-29, 30-39, 40-49, ≥ 50 y), latency (1 to < 5, 5 to < 10, 10 to < 15, ≥ 15 y after HCT), and primary disease (ALL, ANLL, CML, SAA, other). Analyses exclude patients with unknown radiation/unknown radiation dose.
Risk factors for three groups of second cancers are formed based on results from Curtis et al.1 (1) All solid cancers as defined in the previous note, (2) nonsquamous cell invasive solid cancers and nonskin carcinomas in situ, and (3) SCCs (including invasive SCCs of the skin but excluding in situ carcinomas of the skin). Male sex was an additional risk factor for the SCCs (data not shown above): survivors for 1 year or longer, RR was 2.32 (95% CI, 1.29-4.46); 1-4 years after HCT, RR, 1.16 (95% CI, 0.44-3.20); 5 or more years after HCT, RR, 3.52 (95% CI, 1.61-8.80).
Chronic GVHD was moderate or severe grade in CIBMTR patients, or clinically extensive in FHCRC patients.
P < .05.