Second solid cancers after allogeneic stem cell transplantation: The vancouver experience
Bibliographic record
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 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). Six hundred forty pts had a sibling donor and 286 had an unrelated donor. 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 T cell depleted in 43 pts. 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). Of the 28 pts, 6 died from the second cancer at a median of 6.1 months (range 0.9–36) following the diagnosis. The 10-year cumulative incidence of all second solid cancers was 3.1% (95% CI 2–5%). 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 nonmelanoma skin cancer was 1.85 (95% CI 1.04–3.06), P = .019. In multivariate analysis, significant risk factors were recipient age at SCT > 40 years (RR 4.8), P= .01 and donor gender [female donor/male recipient (RR 5.4), female donor/female recipient (RR 2.3)] P= .002. We conclude that allogeneic SCT recipients are at an increased risk of developing a second solid cancer compared to the general population, particularly if the recipient is >40 years old at the time of allografting. It is also apparent that male recipients of a female graft have a higher risk of second solid cancers. 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".