New Cancers in People Who Have Had Bone Marrow Transplants

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The summary below is from the full report titled "Malignant Neoplasms in Long-Term Survivors of Bone Marrow Transplantation." It is in the 16 November 1999 issue of Annals of Internal Medicine (volume 131, pages 738-734). The authors are H.J. Kolb, G. Socié, T. Duell, M.T. Van Lint, A. Tichelli, J.F. Apperley, E. Nekolla, P. Ljungman, N. Jacobsen, M. van Weel, R. Wick, M. Weiss, and H.G. Prentice, for the Late Effects Working Party of the European Cooperative Group for Blood and Marrow Transplantation and the European Late Effect Project Group.

What is the problem and what is known about it so far?

Bone marrow transplant is a type of treatment for some kinds of cancer. It involves giving chemotherapy or radiation treatment to destroy a patient's bone marrow, which is producing cancerous cells, then replacing the bone marrow with bone marrow from a healthy person. Unfortunately, people who have had bone marrow transplants as treatment for cancer seem to be at risk for additional cancers in the future. This may be because of damage from the radiation and chemotherapy.

Why did the researchers do this particular study?

The researchers wanted to find exactly what the risk is for second cancers in people who have had bone marrow transplants.

Who was studied?

The study included 1036 patients who had a bone marrow transplant sometime before 1985 at one of 45 centers in Europe. These patients had transplants to treat cancers of the blood, such as lymphoma, leukemia, and aplastic anemia. To be in the study, patients had to have survived for at least 5 years after the transplant.

How was the study done?

The researchers collected detailed information from the patients' bone marrow transplant medical records. They also searched cancer registries to see which of the patients developed second cancers and to gather information on the types of second cancers that occurred. They then compared the frequency of these second cancers in the bone marrow transplant patients to the frequency of these same cancers in the general population. They also tried to identify whether any aspects, such as patient characteristics, the type of first cancer, to the type of treatment at the time of the bone marrow transplant, seemed to increase the risk for second cancers.

What did the researchers find?

Patients were followed for about 10 years on average. New cancers occurred in 53 of the 1036 patients. Patients who had undergone transplants were almost four times as likely to develop second cancers than were patients in the general population. The most frequent types of second cancers were cancers of the skin (14 patients), mouth (7 patients), uterus or cervix (5 patients), thyroid gland (5 patients), breast (4 patients), or brain (3 patients). The older a patient was at the time of the bone marrow transplant, the higher the risk of developing a second cancer. In addition, patients who had received a medication called cyclosporin A seemed most likely to develop second cancers.

What were the limitations of the study?

The authors were not able to explain exactly why patients who had bone marrow transplants to treat cancers of the blood are at risk for second cancers. It may be something about the first cancer that puts them at risk rather than something about the bone marrow transplant itself. This study included only patients from Europe and may not apply to patients in other places where bone marrow transplant procedures may be different. We also do not know whether these results apply to patients who get bone marrow transplants for other types of cancer or other diseases.

What are the implications of the study?

Patients who have had a bone marrow transplant for cancers of the blood appear to have an increased risk for developing certain types of cancers in the future. However, a small fraction of patients develop second cancers. Only 53 of 1036 patients followed in this study for an average of 10 years developed second cancers. Fortunately, many of the types of cancers that developed are treatable. Doctors who treat patients who have had bone marrow transplants should look for signs of these second cancers.