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Biol Blood Marrow Transplant. 2017 Aug;23(8):1320-1326. doi: 10.1016/j.bbmt.2017.04.004. Epub 2017 Apr 12.

Risk Factors for Subsequent Central Nervous System Tumors in Pediatric Allogeneic Hematopoietic Cell Transplant: A Study from the Center for International Blood and Marrow Transplant Research (CIBMTR).

Author information

1
The Children's Hospital at Westmead, Westmeand, New South Wales, Australia.
2
CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: beshaw@mcw.edu.
3
CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
5
Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
6
University Hospital, Copenhagen, Denmark.
7
Fred Hutchinson Cancer Research Center, Seattle, Washington.
8
Department of Hematology Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
9
Indiana University Hospital/Riley Hospital for Children, Indianapolis, Indiana.
10
Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
11
Schiehallion Day Care Unit, Royal Hospital for Sick Children, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.
12
Division of Bone Marrow Transplant and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
13
Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
14
Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, Michigan.
15
Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
16
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
17
Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland.
18
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
19
Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.

Abstract

Survivors of hematopoietic cell transplantation (HCT) are at risk of subsequent solid tumors, including central nervous system (CNS) tumors. The risk of CNS tumors after HCT in pediatric HCT recipients is not known. We evaluated the incidence and risk factors for CNS tumors in pediatric recipients of allogeneic HCT reported to the Center for International Blood and Marrow Transplant Research between 1976 and 2008. A case control design was used. There were no CNS tumors in the nonmalignant cohort (n = 4543) or in those undergoing HCT for solid tumors (n = 26). There were 59 CNS tumors in 8720 patients transplanted for hematologic malignancies. In comparison with the general population, pediatric HCT recipients with hematologic malignancies had a 33 times higher than expected rate of CNS tumors (95% confidence interval, 22.98 to 45.77; P < .0001). The cumulative incidence of subsequent CNS tumors was 1.29% (95% confidence interval .87 to 1.87) at 20 years after HCT. Significant risk factors in the entire cohort were having an unrelated donor (HR, 3.35; P = .0002) and CNS disease before HCT for both acute lymphoblastic leukemia (HR, 8.21; P = .0003) and acute myeloid leukemia (HR, 6.21; P = .0174). Analysis of the matched cohort showed having an unrelated donor transplant (HR, 4.79; P = .0037), CNS disease before HCT (HR, 7.67; P = .0064), and radiotherapy exposure before conditioning (HR, 3.7; P = .0234) to be significant risk factors. Chronic graft-versus-host disease was associated with a lower risk (HR, .29; P = .0143). Survivors of HCT for nonmalignant diseases did not show an increased incidence of CNS tumors, whereas survivors of hematologic malignancies have a markedly increased incidence of CNS tumors that warrants lifelong surveillance.

KEYWORDS:

Allogeneic hematopoietic stem cell transplant; Central nervous system tumors; Risk factors for subsequent tumors; Subsequent tumors

PMID:
28411175
PMCID:
PMC5518678
DOI:
10.1016/j.bbmt.2017.04.004
[Indexed for MEDLINE]
Free PMC Article

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