H. J. Kolb, MD, PhD; Gérard Socié, MD, PhD; Thomas Duell, MD; Maria Theresa Van Lint, MD; André Tichelli, MD; Jane F. Apperley, MD; Elke Nekolla, PhD; Per Ljungman, MD, PhD; Niels Jacobsen, MD, PhD; M. van Weel, MD; Roland Wick, PhD; Melanie Weiss, MD; H. Grant Prentice, MB, FRCP, FRCPath; Late Effects Working Party of the European Cooperative Group for Blood and Marrow Transplantation and the European Late Effect Project Group
Grant Support: In part by the European Late Effect Project Group and Council Economic Community contract FI3P-CT920064f—epidemiologic studies and tables.
Requests for Reprints: H.J. Kolb, MD, PhD, Hematopoietic Cell Transplantation, Medical Clinic III, University of Munich, Marchioninistrasse 15, 81377 München, Germany.
Current Author Addresses: Drs. Kolb and Duell: Hematopoietic Cell Transplantation, Medical Clinic III, GSF-National Research Center for Environment and Health, Marchioninistrasse 15, 81377 München, Germany.
Drs. Nekolla and Wick: Radiobiological Institute, GSF-National Research Center for Environment and Health, Ingolstädter Landstrasse 1, München-Neuherberg, Germany.
Dr. Socié: Hôpital St. Louis, Centre Hayem, 1 avenue Claude Vellefaux, 750475 Paris, France.
Dr. Van Lint: Ospedale San Martino, Centro Trapianti Midollo Osseo, Divisione Ematologia, Viale Benedetto XV, 1-16132 Genova, Italy.
Dr. Tichelli: Kantonsspital Basel, Department of Haematology, Petersgraben 4, CH 4041 Basel, Switzerland.
Dr. Apperley: Hammersmith Hospital, Royal Postgraduate School of Medicine, DuCane Road 4, London, United Kingdom.
Dr. Ljungman: Department of Medicine, Huddinge Hospital, Huddinge, Sweden.
Dr. Jacobsen: BMT Unit Blegdamsvej, 9 Rigshospitalet, Copenhagen, Denmark.
Dr. van Weel: Department of Pediatrics, University Hospital, Leiden, Netherlands.
Dr. Weiss: Institut für Arbeitsmedizin, Universität Ulm, Ulm, Germany.
Dr. Prentice: Royal Free Hospital London, Hampstead, London, United Kingdom.
Kolb H., Socié G., Duell T., Van Lint M., Tichelli A., Apperley J., Nekolla E., Ljungman P., Jacobsen N., van Weel M., Wick R., Weiss M., Prentice H., ; Malignant Neoplasms in Long-Term Survivors of Bone Marrow Transplantation. Ann Intern Med. 1999;131:738-744. doi: 10.7326/0003-4819-131-10-199911160-00004
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Published: Ann Intern Med. 1999;131(10):738-744.
Bone marrow transplantation offers a chance for cure to patients with leukemia, lymphoma, and severe aplastic anemia (1-3). However, long-term survival may be impaired by the development of secondary neoplasms (4). Secondary malignant diseases are known complications of the radiation and chemotherapy used to treat primary cancers (5-7). An increased risk for malignant neoplasms has also been reported in patients who receive organ transplants (8, 9) and those treated with immunosuppression for aplastic anemia (10). Patients who receive marrow transplants are at increased risk for malignant neoplasms because of several risk factors: ionizing radiation and chemotherapy used for pretransplantation conditioning and treatment of the primary malignant disease, immune deficiency due to delayed and incomplete recovery of the immune system, immune stimulation and immunosuppression by the graft-versus-host reaction, and immunosuppressive therapy for graft-versus-host disease. Most reports on malignant neoplasm after marrow transplantation have included patients early after transplantation and have had short follow-up (1, 4, 11-15). A recent multicenter study of more than 19 000 patients (16) included patients early after transplantation and evaluated solid cancers only.
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