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Allogeneic‐HCT recipients have a two‐ to threefold increased risk of developing this very late effect [59, 79]. Solid malignancies are the fourth leading cause of mortality in patients surviving more than 2 years post‐HCT. The pattern of increase is linear over time: 1.2–1.6% at 5 years, 2.2–6.1% at 10 years, and 3.8–14.9% at 15 years [60–63]. Certain conditions significantly increase the risk, particularly Fanconi anemia in which routine surveillance strategies for head/neck cancers should be utilized. Common solid cancers seen in allogeneic‐HCT survivors include thyroid, skin, oropharyngeal, and breast cancers.

Thyroid cancer is the fastest‐growing non‐skin cancer in the USA [64], and its incidence is even higher in HCT recipients. A study from the EBMT Late‐Effects Working Party suggested a threefold higher incidence of thyroid cancer in HCT recipients than in the general population [65]. TBI, female gender, and cGVHD were found to be risk factors. A vigilant clinical exam of the thyroid gland and cervical nodes at yearly intervals is recommended.

Skin cancers are the most common solid malignancies post‐HCT. In a large series, the 20‐year cumulative incidences of basal cell and squamous cell cancers were reported to be 6.5% and 3.4%, respectively [66]. TBI and GVHD were found to be risk factors. An annual dermatologic examination for skin cancer screening is recommended.

Breast cancer risk is elevated among HCT recipients, with a reported cumulative incidence of 11% at 25 years post‐HCT [67]. Risk factors include TBI and prior chemotherapies. Annual mammography is recommended.