Second Solid Cancers after Allogeneic Stem Cell Transplantation: The Vancouver Experience.
Notice bibliographique
Résumé
Abstract The development of second solid cancers in recipients of hematopoietic stem cell transplants (SCT) represents a serious complication among long term survivors. To assess the incidence and associated risk factors for second solid cancers following allogeneic SCT we performed a retrospective analysis of 926 consecutive patients (pts) who underwent an allogeneic (n=918) or syngeneic (n=8) SCT between January 1985 and December 2003. Primary diagnoses were AML (235), ALL (103), CML (216), lymphoproliferative disorders (150), MDS (96), MM (80) or other (46). Median age at SCT was 39 years (range 12–65) and median time from diagnosis to SCT was 5.1 months (range 0.2–345). 640 pts had a sibling donor (602 matched/38 mismatched) and 286 had an unrelated donor (225 matched/61 mismatched). Stem cell source was bone marrow (810), peripheral blood (109) or both (7). Conditioning regimens were: TBI-based (488), BuCy +/− other (414), other (24). The graft was unmanipulated in 883 pts and T-cell depleted in 43 pts. GvHD prophylaxis consisted of CSA and MTX in 84%. With a median follow-up of 22.2 months post SCT (range 0.07–230.5) for all 926 pts and 84.2 months (range 8.4–230.5) for surviving pts, 30 solid malignancies have occurred in 28 pts at a median of 81.4 months post SCT (range 1.4–207.5). These second tumors involved skin (8 basal cell carcinoma, 4 invasive squamous cell carcinoma), lung (5), oral cavity (4), colon (2), bladder (2) breast (1), kidney (1), parotid gland (1), vulva-in situ (1) and primary unknown (1). 6 of the 28 pts died from the second cancer at a median of 6.1 months (range 0.9–36) following the diagnosis. The cumulative incidence of all second solid cancers at 10 and 15 years was 3.1% (95% CI 2–5%) and 5.7% (95% CI 3–9%), respectively. Excluding basal cell carcinoma and carcinoma in situ, the 10 and 15-year cumulative incidence rates were 2.3% (95% CI 1–4%) and 4.0% (95% CI 2–6%), respectively. Compared to age and gender adjusted cancer rates in the general population of BC, the relative risk (RR) of developing a second solid cancer after allografting excluding basal cell carcinoma and squamous cell carcinoma of the skin was 1.85 (95% CI 1.04–3.06), p =0.019. Risk factors evaluated included initial diagnosis, gender, age at SCT, donor gender, donor age, interval from diagnosis to SCT, year of SCT, source of stem cells, HLA disparity, conditioning regimen, T cell depletion, prior history of radiation therapy, incidence of aGvHD, incidence of cGvHD and aGvHD therapy. In multivariate analysis, significant risk factors were recipient age at SCT >40 years (RR 4.8), p=0.01 and donor gender [female donor/male recipient (RR 5.4), female donor/female recipient (RR 2.3)] p=0.002. We conclude that allogeneic SCT recipients are at an increased risk of developing a second solid cancer as compared to the general population, particularly if the recipient is >40 years at the time of allografting. It is also apparent that male recipients of a female graft have a high risk of second solid cancers. Since we did not find an association between second cancers and aGvHD or cGvHD in our analysis, is it interesting to speculate whether this is somehow related to subclinical GvHD. Regardless, longer follow-up is needed to more fully assess the incidence and risk factors for second solid tumors post-transplant due to their long latency period.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».