Gündüz Mehmet, Özen Mehmet, Şahin Uğur, Toprak Selami Koçak, Civriz Bozdağ Sinem, Kurt Yüksel Meltem, Arslan Önder, Özcan Muhit, Demirer Taner, Beksaç Meral, İlhan Osman, Gürman Günhan, Topçuoğlu Pervin
Department of Hematology, Ataturk Training and Research Hospital, Ankara, Turkey.
Department of Hematology, Ufuk University Faculty of Medicine, Ankara, Turkey.
Clin Transplant. 2017 Jul;31(7). doi: 10.1111/ctr.12987. Epub 2017 May 25.
We evaluated 979 patients for the development of post-transplant lymphoproliferative disease (PTLD) and solid malignancies after allogeneic hematopoietic stem cell transplantations (allo-HSCT) as a late complication. We found 15 (1.5%) subsequent malignancies; three of these malignancies were PTLD, and twelve were solid tumors. The median time from allo-HSCT to the development of PTLD was 9 (3-20) months and that from allo-HSCT to the development of solid tumors was 93 (6-316) months. The cumulative incidence of evolving subsequent malignancy in patients was 1.3% (±0.5 SE) at 5 years and 3.9% (±1.2 SE) at 10 years. The cumulative incidence of developing subsequent malignancy in patients with benign hematological diseases as the transplant indication was 7.4%±4.2 SE at 5 years. More subsequent malignancy developed in patients having ≥1 year chronic graft-vs-host disease (GVHD; 3.7% in ≥1 year chronic GVHD and 0.7% in <1 year chronic GVHD patient groups, P=.002). Subsequent epithelial tumor risk was higher in ≥1 year chronic GVHD patients than <1 year (3.7% vs 0.1%, P<.001). In multivariate analysis, benign hematological diseases as transplant indication (RR: 5.6, CI 95%: 1.4-22.3, P=.015) and ≥1 year chronic GVHD (RR: 7.1, 95% CI: 2.3-22.5, P=.001) were associated with the development of subsequent malignancy.
我们评估了979例接受异基因造血干细胞移植（allo-HSCT）的患者，以观察移植后淋巴细胞增殖性疾病（PTLD）和实体恶性肿瘤作为晚期并发症的发生情况。我们发现了15例（1.5%）后续发生的恶性肿瘤；其中3例为PTLD，12例为实体瘤。从allo-HSCT到PTLD发生的中位时间为9（3 - 20）个月，从allo-HSCT到实体瘤发生的中位时间为93（6 - 316）个月。患者发生后续恶性肿瘤的累积发生率在5年时为1.3%（±0.5 SE），在10年时为3.9%（±1.2 SE）。以良性血液系统疾病作为移植指征的患者发生后续恶性肿瘤的累积发生率在5年时为7.4%±4.2 SE。慢性移植物抗宿主病（GVHD）≥1年的患者发生更多后续恶性肿瘤（≥1年慢性GVHD患者组为3.7%，<1年慢性GVHD患者组为0.7%，P = 0.002）。慢性GVHD≥1年的患者发生后续上皮性肿瘤的风险高于<1年的患者（3.7%对0.1%，P < 0.001）。多因素分析显示，以良性血液系统疾病作为移植指征（RR：5.6，95%CI：1.4 - 22.3，P = 0.015）和慢性GVHD≥1年（RR：7.1，95%CI：2.3 - 22.5，P = 0.001）与后续恶性肿瘤的发生相关。
