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Risk factors for the development of cutaneous melanoma after allogeneic hematopoietic cell transplantation - 03/03/20

Doi : 10.1016/j.jaad.2019.10.034 
Megan M. Herr, PhD a, b, Rochelle E. Curtis, MA a, Margaret A. Tucker, MD a, Heather R. Tecca, MPH c, Eric A. Engels, MD MPH a, Elizabeth K. Cahoon, PhD a, Minoo Battiwalla, MD, MS d, David Buchbinder, MD e, Mary E. Flowers, MD f, Ruta Brazauskas, PhD c, Bronwen E. Shaw, MBChB, PhD c, Lindsay M. Morton, PhD a,
a Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 
b Roswell Park Comprehensive Cancer Center, Buffalo, New York 
c Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin 
d Sarah Cannon Blood Cancer Network, Nashville, Tennessee 
e Department of Hematology and Bone Marrow Transplant, Children's Hospital of Orange County, Orange, California 
f Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington 

Correspondence to: Lindsay M. Morton, PhD; Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services; 9609 Medical Center Dr, Room 7E-454, MSC 9778; Bethesda, MD 20892-9778.Radiation Epidemiology BranchDivision of Cancer Epidemiology and GeneticsNational Cancer InstituteNational Institutes of HealthDepartment of Health and Human Services9609 Medical Center Dr, Room 7E-454, MSC 9778BethesdaMD20892-9778
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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.
 Conflicts of interest: None disclosed.
 IRB approval status: Exempt from ethics committee review at the National Cancer Institute.


© 2020  Publié par Elsevier Masson SAS.
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