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. 2019 Dec;145(12):3125-3135.
doi: 10.1007/s00432-019-03039-2. Epub 2019 Nov 5.

"Risk of de novo or secondary cancer after solid organ or allogeneic haematopoietic stem cell transplantation"

Neval E Wareham  1 , Qiuju Li  2 , Henrik Sengeløv  3 , Caspar Da Cunha-Bang  4 , Finn Gustafsson  4 , Carsten Heilmann  5 , Michael Perch  4 , Allan Rasmussen  6 , Søren Schwartz Sørensen  7 , Amanda Mocroft  2 , Jens D Lundgren  8
Affiliations

"Risk of de novo or secondary cancer after solid organ or allogeneic haematopoietic stem cell transplantation"

Neval E Wareham et al. J Cancer Res Clin Oncol. 2019 Dec.

Abstract

Purpose: Solid organ (SOT) and allogeneic haematopoietic stem cell (HSCT) transplant recipients have elevated risks of de novo or secondary cancer. We explored risk factors hereof.

Methods: Among SOT and HSCT between January 2004 and December 2014, standardised incidence ratio (SIR) of de novo/secondary cancer compared with the Danish population was determined and risk factors were identified using Poisson regression.

Results: During a median of 3.4 (IQR 1.3-6.4) and 2.6 (0.8-5.4) person-years (PY) after SOT and HSCT, a total of 212/1656 (13%) and 75/992 (8%) persons developed cancer; SIR 3.61 (3.0-4.3) and 2.2 (1.6-3.0), resp.). SIR correlated with younger age and was highest for skin and haematological cancers for both types of transplantation. Within the cohort, cancer was associated with older age (adjusted incidence rate ratio > 50 vs ≤ 19 years, among SOT and HSCT: 9.4 (3.4-25.7) and 25.4 (5.1-126.0), resp.) and current elevated C-reactive protein (CRP) (≥ 10 vs < 10 mg/L: 2.5 (1.8-3.4) and 2.3 (1.4-3.9), resp.), but neither with prior cancer nor type of immunosuppressants.

Conclusion: Rates of de novo or secondary cancers are elevated in both SOT and HSCT compared with the general population and mainly for skin and haematological cancers. Among transplant recipients, older age and current elevated CRP are risk factors.

Keywords: Cancer; Inflammation; Secondary cancer; Transplantation.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a standardised incidence ratio of cancer after solid organ (SOT) and haematopoietic stem cell transplantation (HSCT) compared to the Danish population, according to cancer type. b Standardised incidence ratio of cancer after solid organ (SOT) and haematopoietic stem cell transplantation (HSCT) compared to the Danish population, according to age at cancer diagnosis. Abbreviation: SOT solid organ transplantation, HSCT haematopoietic stem cell transplantation, SIR standardized incidence ratio, CI confidence interval
Fig. 2
Fig. 2
a Incidence rate ratios of any cancer at various time points prior to cancer diagnosis of elevated CRP compared to normal values, among SOT. b Incidence rate ratios of any cancer at various time points prior to cancer diagnosis of elevated CRP compared to normal values, among HSCT. Abbreviations: CRP C-reactive protein. Models adjusted for gender, age, transplant year, transplant type, number of transplantations, pre-transplant cancer, Charlson score
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