In a study reported in JAMA Oncology, McDonald et al found that receipt of blood or marrow transplantation (BMT) was associated with an increased risk of subsequent malignant neoplasms of the gastrointestinal (GI) tract.

As stated by the investigators, “Survivors of BMT are at increased risk of subsequent malignant neoplasms. Cancers of the GI system are of special interest because their clinical behavior is often aggressive, necessitating early detection by increasing awareness of high-risk populations.”

Study Details

The study involved data on 6,710 patients who lived for at least 2 years after BMT performed between January 1974 and December 2014 at City of Hope, the University of Minnesota, or the University of Alabama at Birmingham. End of follow-up was in March 2020. Standardized incidence ratios (SIRs) were used to compare risk of GI cancers in BMT survivors compared with the general population.

Key Findings

Among the 6,710 patients, 3,444 received autologous and 3,266 received allogeneic BMT. The most common diagnoses in BMT recipients were non-Hodgkin lymphoma, acute myeloid leukemia or myelodysplastic syndrome, and plasma cell dyscrasias. Median age at BMT was 46 years (range = 0–78 years).

After 62,479 person-years of follow-up, 148 patients developed subsequent malignant neoplasms in the GI tract at a median of 8.9 years (range = 0.3–36.6 years) from BMT (SIR = 3.6, 95% confidence interval [CI] = 3.0–4.2).

Among individual subsequent malignant neoplasms, risks were significantly elevated among BMT recipients for liver (SIR = 8.1, 95% CI = 5.7–11.0), esophageal (SIR = 7.8, 95% CI = 5.0–11.6), pancreatic (SIR = 4.9, 95% CI = 3.3–7.0), gastric (SIR = 3.1, 95% CI = 1.6–5.3), and colorectal cancers (SIR = 2.1, 95% CI = 1.6–2.8). Allogeneic BMT recipients had higher risks of specific subsequent malignant neoplasms, with standardized incidence ratios ranging from 3.1 (95% CI = 1.9–4.6) for colorectal cancer to 22.4 (95% CI = 13.6–34.4) for esophageal cancer.

Among specific treatment-related risk factors for subsequent malignant neoplasms, exposure to cytarabine in conditioning was associated with an increased risk of colorectal cancer (subdistribution hazard ratio [SHR] = 3.1, 95% CI = 1.5–6.6). Compared with autologous BMT recipients, allogeneic BMT recipients with chronic graft-vs-host disease were at an increased risk for esophageal cancer (SHR = 9.9, 95% CI = 3.2–30.5). Conditioning with etoposide (SHR = 2.0, 95% CI = 1.1–3.5) and pre-BMT anthracycline exposure (SHR = 5.4, 95% CI = 1.3–23.4) were associated with an increased risk of liver cancer vs no exposure to either agent.

The investigators concluded, “The findings of this cohort study are relevant for oncologists and nononcologists who care for the growing number of survivors of transplant. Awareness of subgroups of survivors of BMT at high risk for specific types of subsequent malignant neoplasms in the GI tract may influence recommendations regarding modifiable risk factors, as well as individualized screening.”

Smita Bhatia, MD, MPH, of the Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, is the corresponding author for the JAMA Oncology article.

Disclosure: The study was supported by the National Cancer Institute and Leukemia and Lymphoma Society. For full disclosures of the study authors, visit jamanetwork.com.