Risk factors for the development of cutaneous melanoma after allogeneic hematopoietic cell transplantation - 03/03/20
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Abstract |
Background |
Melanoma risk is increased after allogeneic hematopoietic cell transplantation (HCT), but specific risk factors are unknown.
Objective |
Investigate risk factors for melanoma after allogeneic hematopoietic cell transplantation.
Methods |
We conducted a nested case-control study of 140 melanoma cases and 557 controls (matched by age at HCT, sex, primary disease, survival time) through the Center for International Blood and Marrow Transplant Research.
Results |
Melanoma risk was significantly increased among HCT survivors who received total body irradiation-based myeloablative conditioning (multivariable adjusted odds ratio [OR] = 1.77; 95% confidence interval [CI] = 1.00-3.15) or reduced-intensity conditioning containing melphalan (OR = 2.60; 95% CI = 1.13-6.02) or fludarabine (OR = 2.72; 95% CI = 1.02-7.30) versus busulfan-based myeloablative regimens; were diagnosed with acute graft-versus-host disease (GVHD) with stage 2+ skin involvement (OR = 1.92; 95% CI = 1.19-3.10), chronic GvHD without skin involvement (OR = 1.91; 95% CI = 1.03-3.57), or keratinocytic carcinoma (OR = 2.37; 95% CI = 1.16-4.83); and resided in areas with higher ambient ultraviolet radiation (ORtertile3 = 1.64; 95% CI = 1.01-2.67).
Limitations |
Data on individual-level ultraviolet radiation exposure and clinical data on melanoma characteristics were lacking. Additionally, misclassification of melanoma is possible as not all pathology reports were available for review.
Conclusion |
These results emphasize the importance of adherence to current surveillance guidelines (routine skin examination, photoprotection recommendations), particularly for HCT survivors at highest risk.
Le texte complet de cet article est disponible en PDF.Key words : allogeneic hematopoietic stem cell transplantation, ionizing radiation, late effects, melanoma, ultraviolet radiation
Plan
Funding sources: Supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health, Department of Health and Human Services. The Center for International Blood and Marrow Transplant Research is supported primarily by Public Health Service grant/cooperative agreement 5U24CA076518 from the National Cancer Institute (NCI); the National Heart, Lung, and Blood Institute (NHLBI); and the National Institute of Allergy and Infectious Diseases; by grant/cooperative agreement 4U10HL069294 from the NHLBI and the NCI; by contract HHSH250201200016C with the Health Resources and Services Administration/Department of Health and Human Services; by 2 grants (N00014-17-1-2388 and N0014-17-1-2850) from the Office of Naval Research; by grants from corporate members (Actinium Pharmaceuticals, Inc; Amgen, Inc; Amneal Biosciences; and Angiocrine Bioscience, Inc); by an anonymous donation to the Medical College of Wisconsin; by Astellas Pharma US; Atara Biotherapeutics, Inc; Be The Match Foundation; bluebird bio, Inc (corporate member); Bristol-Myers Squibb Oncology (corporate member); Celgene Corporation (corporate member); Cerus Corporation; Chimerix, Inc (corporate member); the Fred Hutchinson Cancer Research Center; Gamida Cell Ltd; Gilead Sciences, Inc; HistoGenetics, LLC; Immucor; Incyte Corporation (corporate member); Janssen Scientific Affairs, LLC; Jazz Pharmaceuticals, Inc (corporate member); Juno Therapeutics; Karyopharm Therapeutics, Inc; Kite Pharma, Inc; Medac, GmbH; MedImmune; the Medical College of Wisconsin; Mediware (corporate member); Merck & Company, Inc (corporate member); Mesoblast Ltd (corporate member); Meso Scale Diagnostics, LLC; Millennium Pharmaceuticals, the Takeda Oncology Company; Miltenyi Biotec, Inc (corporate member); the National Marrow Donor Program; Neovii Biotech NA, Inc (corporate member); Novartis Pharmaceuticals Corporation; Otsuka Pharmaceutical Co, Ltd; PCORI; Pfizer, Inc (corporate member); Pharmacyclics, LLC (corporate member); PIRCHE AG; Sanofi Genzyme (corporate member); Seattle Genetics (corporate member); Shire; Spectrum Pharmaceuticals, Inc; St. Baldrick's Foundation; Sunesis Pharmaceuticals, Inc (corporate member); Swedish Orphan Biovitrum AB; Takeda Oncology; Telomere Diagnostics, Inc; and the University of Minnesota. |
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Conflicts of interest: None disclosed. |
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IRB approval status: Exempt from ethics committee review at the National Cancer Institute. |
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