Inamoto Y, Shah N N, Savani B N, Shaw B E, Abraham A A, Ahmed I A, Akpek G, Atsuta Y, Baker K S, Basak G W, Bitan M, DeFilipp Z, Gregory T K, Greinix H T, Hamadani M, Hamilton B K, Hayashi R J, Jacobsohn D A, Kamble R T, Kasow K A, Khera N, Lazarus H M, Malone A K, Lupo-Stanghellini M T, Margossian S P, Muffly L S, Norkin M, Ramanathan M, Salooja N, Schoemans H, Wingard J R, Wirk B, Wood W A, Yong A, Duncan C N, Flowers M E D, Majhail N S
Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institute of Health (NIH), Bethesda, MD, USA.
Bone Marrow Transplant. 2015 Aug;50(8):1013-23. doi: 10.1038/bmt.2015.63. Epub 2015 Mar 30.
Hematopoietic stem cell transplant (HCT) recipients have a substantial risk of developing secondary solid cancers, particularly beyond 5 years after HCT and without reaching a plateau overtime. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal to facilitate implementation of cancer screening appropriate to HCT recipients. The working group reviewed guidelines and methods for cancer screening applicable to the general population and reviewed the incidence and risk factors for secondary cancers after HCT. A consensus approach was used to establish recommendations for individual secondary cancers. The most common sites include oral cavity, skin, breast and thyroid. Risks of cancers are increased after HCT compared with the general population in skin, thyroid, oral cavity, esophagus, liver, nervous system, bone and connective tissues. Myeloablative TBI, young age at HCT, chronic GVHD and prolonged immunosuppressive treatment beyond 24 months were well-documented risk factors for many types of secondary cancers. All HCT recipients should be advised of the risks of secondary cancers annually and encouraged to undergo recommended screening based on their predisposition. Here we propose guidelines to help clinicians in providing screening and preventive care for secondary cancers among HCT recipients.
造血干细胞移植（HCT）受者发生继发性实体癌的风险很大，尤其是在HCT后5年以上，且随着时间推移并未达到稳定状态。通过国际血液和骨髓移植研究中心以及欧洲血液和骨髓移植组成立了一个工作组，目标是促进对HCT受者进行适当的癌症筛查。该工作组审查了适用于普通人群的癌症筛查指南和方法，并审查了HCT后继发性癌症的发病率和危险因素。采用共识方法为个别继发性癌症制定建议。最常见的部位包括口腔、皮肤、乳腺和甲状腺。与普通人群相比，HCT后皮肤、甲状腺、口腔、食管、肝脏、神经系统、骨骼和结缔组织发生癌症的风险增加。清髓性全身照射、HCT时年龄较小、慢性移植物抗宿主病以及超过24个月的长期免疫抑制治疗是多种类型继发性癌症的充分记录的危险因素。应每年向所有HCT受者告知继发性癌症的风险，并鼓励他们根据自身易感性接受推荐的筛查。在此，我们提出指南，以帮助临床医生为HCT受者的继发性癌症提供筛查和预防性护理。
