[Mark11]

Secondary Cancers After Transplant on Par with US Population

by Mark11 on Tue Apr 07, 2015 8:46 pm

New study looking at risk of secondary cancers after auto transplant was just published. Fortunately it does not appear that there was an increased risk of secondary cancer when compared to the US population overall. Slightly higher risk of melanoma and AML. An older study showed patients with MGUS had a higher incidence of AML/certain melanomas than the general population, so the increase may not be related to transplantation.

"We describe baseline incidence and risk factors for new cancers in 4161 persons receiving autotransplants for multiple myeloma in the United States from 1990 to 2010. Observed incidence of invasive new cancers was compared with expected incidence relative to the US population. The cohort represented 13,387 person-years at-risk. In total, 163 new cancers were observed, for a crude incidence rate of 1.2 new cancers per 100 person-years and cumulative incidences of 2.6% (95% confidence interval [CI], 2.09 to 3.17), 4.2% (95% CI, 3.49 to 5.00), and 6.1% (95% CI, 5.08 to 7.24) at 3, 5, and 7 years, respectively. The incidence of new cancers in the autotransplantation cohort was similar to age-, race-, and gender-adjusted comparison subjects with an observed/expected (O/E) ratio of 1.00 (99% CI, .81 to 1.22). However, acute myeloid leukemia and melanoma were observed at higher than expected rates with O/E ratios of 5.19 (99% CI, 1.67 to 12.04; P = .0004), and 3.58 (99% CI, 1.82 to 6.29; P < .0001), respectively. Obesity, older age, and male gender were associated with increased risks of new cancers in multivariate analyses. This large data set provides a baseline for comparison and defines the histologic type specific risk for new cancers in patients with multiple myeloma receiving postautotransplantation therapies, such as maintenance.

http://www.bbmt.org/article/S1083-8791(14)01472-4/abstract


"An excess risk of nonmelanoma skin cancer was observed subsequent to both multiple myeloma (SIR = 2.22; 1.74-2.80) and MGUS (SIR = 3.30; 2.76-3.90). Our novel observations of an excess risk for AML/MDS following IgG/IgA (but not IgM) MGUS, and the highest risk associated with M-protein concentrations > 1.5 g/dL, support a role for nontreatment-related factors in plasma cell dyscrasias. AML/MDS risk following multiple myeloma was the same before/after the introduction of HDM-ASCT. Longer follow-up is needed to characterize second tumor risks in the IMiD era."

http://www.ncbi.nlm.nih.gov/pubmed/21795746

[Rneb]

Re: Secondary Cancers After Transplant on Par with US Popula

by Rneb on Wed Apr 08, 2015 8:44 am

Of course, two items bear mentioning.

Do the statistics based on TWO TUMORS/cancers -- myeloma and the secondary tumor/ cancer.(instead of one).

Second, remember what Mark Twain said about statistics.

[Mike F]

Re: Secondary Cancers After Transplant on Par with US Popula

by Mike F on Thu Apr 09, 2015 12:07 am

Thanks for that, Mark. It's nice to know that this doesn't appear to be a worrisome issue. The last thing anyone with myeloma needs is another form of cancer.