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Br J Cancer. 2015 Jan 6;112(1):177-84. doi: 10.1038/bjc.2014.523. Epub 2014 Oct 14.

Use of azathioprine for graft-vs-host disease is the major risk for development of secondary malignancies after haematopoietic stem cell transplantation: a nationwide population-based study.

Author information

1
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Shipai Road, Section 2, Taipei 11217, Taiwan.
2
1] Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Shipai Road, Section 2, Taipei 11217, Taiwan [2] Institute of Public Health, National Yang-Ming University, Taipei, Taiwan [3] School of Medicine, National Yang-Ming University, Taipei, Taiwan.
3
1] School of Medicine, National Yang-Ming University, Taipei, Taiwan [2] Division of Hematology and Oncology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
4
1] School of Medicine, National Yang-Ming University, Taipei, Taiwan [2] Division of Oncology and Heamtology, Department of Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
5
1] Institute of Public Health, National Yang-Ming University, Taipei, Taiwan [2] School of Medicine, National Yang-Ming University, Taipei, Taiwan [3] Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.
6
1] Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan [2] Department of information management, National Chung-Cheng University, Chiayi, Taiwan.
7
Department of Hematology and Oncology, Show Chwan Memorial Hospital, Changhua, Taiwan.
8
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
9
1] School of Medicine, National Yang-Ming University, Taipei, Taiwan [2] Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
10
1] Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Shipai Road, Section 2, Taipei 11217, Taiwan [2] School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Abstract

BACKGROUND:

As more patients are treated by haematopoietic stem cell transplantation (HSCT), development of secondary malignancy (SM) becomes an increasingly common issue in long-term survivors.

METHODS:

We conducted a nationwide population-based study of the Taiwanese population to analyse patients who received HSCT between January 1997 and December 2010. Standardised incidence ratios (SIRs) were used to compare the risk of SM in HSCT patients and the general population. Multivariate analysis was performed to identify independent predictors of SM.

RESULTS:

Patients receiving HSCT had a significantly greater risk of developing SM (SIR 2.00; 95% confidence interval (CI) 1.45-2.69; P<0.001). Specifically, the incidence increased for cancers of the oral cavity (SIR 14.18) and oesophagus (SIR 14.75) after allogeneic HSCT. Multivariate analysis revealed an increased SIR for cancer in patients who received the immunosuppressant azathioprine. The risk of SM also increased with greater cumulative doses of azathioprine.

CONCLUSIONS:

This study demonstrates an increased incidence of SM in Taiwanese patients who received allogeneic HSCT, especially for cancers of the oral cavity and oesophagus. This finding is different from results in populations of Western countries. Physicians should be cautious about azathioprine use for graft-vs-host disease after HSCT.

PMID:
25314066
PMCID:
PMC4453596
DOI:
10.1038/bjc.2014.523
[Indexed for MEDLINE]
Free PMC Article

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