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)
Year: 2017
Type: article
Study design: Observational Study
Abstract: 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.
Authors: Melissa Gabriel, Bronwen E. Shaw, Ruta Brazauskas, 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
Institutions: Children's Hospital at Westmead, Medical College of Wisconsin, Children's Hospital of Wisconsin, Copenhagen University Hospital, Fred Hutch Cancer Center, Children's Mercy Hospital, Indiana University Hospital, Riley Hospital for Children, University Hospitals of Cleveland, University Hospitals Cleveland Medical Center, University Hospitals Seidman Cancer Center, NHS Greater Glasgow and Clyde, Royal Hospital for Children, Cincinnati Children's Hospital Medical Center, Baylor College of Medicine, Spectrum Health, Helen DeVos Children's Hospital, Chinese University of Hong Kong, Prince of Wales Hospital, National Heart, Lung, and Blood Institute, Vanderbilt University Medical Center, Cleveland Clinic
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W2606456098