9. Secondary malignancies: prevalence, screening, prevention, and management guidelines

  1. Bipin N Savani MD
  1. Paolo F Caimi and
  2. Hillard M Lazarus

Published Online: 6 SEP 2013

DOI: 10.1002/9781118473306.ch9

Blood and Marrow Transplantation Long-Term Management: Prevention and Complications

Blood and Marrow Transplantation Long-Term Management: Prevention and Complications

How to Cite

Caimi, P. F. and Lazarus, H. M. (2013) Secondary malignancies: prevalence, screening, prevention, and management guidelines, in Blood and Marrow Transplantation Long-Term Management: Prevention and Complications (ed B. N. Savani), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118473306.ch9

Editor Information

  1. Professor of Medicine,Director, Long Term Transplant Clinic, Hematology and Stem Cell Transplantation Section, Vanderbilt University Medical Center, Nashville, TN, USA

Author Information

  1. Department of Medicine, Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH, USA

Publication History

  1. Published Online: 6 SEP 2013
  2. Published Print: 1 OCT 2013

ISBN Information

Print ISBN: 9781118473405

Online ISBN: 9781118473306

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Keywords:

  • secondary neoplasms;
  • posttransplant lymphoproliferative disorder;
  • treatment-related myeloid neoplasms;
  • surveillance

Summary

Recipients of autologous and allogeneic hematopoietic progenitor cell transplant (HPCT) have a significantly elevated risk of secondary neoplasms when compared with an age-adjusted normal population. These complications follow three major models: posttransplant lymphoproliferative disorders (PTLDs), primarily associated with allogeneic HPCT; secondary myeloid neoplasms, occurring most commonly after autologous HPCT; and secondary solid malignancies, occurring both after autologous and allogeneic HPCT and whose incidence continues to increase decades after transplantation. The risk factors for development of secondary malignancies include: (1) pretransplant parameters, such as patient age, gender, and primary malignancy; (2) transplant characteristics, in particular the use of total body radiation therapy in the conditioning regimen; and (3) posttransplant factors, including the development of chronic graft-versus-host disease and the use of chronic immunosuppression. Early identification of secondary neoplasm through surveillance of pre-cancerous conditions is essential in order to improve patient outcome. Treatment of PTLD is focused on the early eradication of an Epstein–Barr virus-containing B cell population, while treatment of secondary myeloid malignancies and solid tumors requires a careful and varied approach given the heightened risk of treatment-related complications and less favorable outcomes. Both physicians and HPCT recipients must be aware of the need for lifelong surveillance and monitoring for the development of posttransplant secondary malignancies.