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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)

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

  • Melissa Gabriel
  • Bronwen E Shaw
  • Ruta Brazauskas
  • Wei-Min Chen
  • David A Margolis
  • Henrik Sengelov
  • Ann Dahlberg
  • Ibrahim A Ahmed
  • David Delgado
  • Hillard M Lazarus
  • Brenda Gibson
  • Kasiani C Myers
  • Rammurti T Kamble
  • Aly Abdel-Mageed
  • Chi Kong Li
  • Mary E D Flowers
  • Minoo Battiwalla
  • Bipin N Savani
  • Navneet Majhail
  • Peter J Shaw
Vis graf over relationer

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.

OriginalsprogEngelsk
TidsskriftBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Vol/bind23
Udgave nummer8
Sider (fra-til)1320-1326
Antal sider7
ISSN1083-8791
DOI
StatusUdgivet - aug. 2017

ID: 51608442