Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 155

Secondary malignancies are a known complication of conventional chemotherapy and radiation treatment for patients with a variety of primary cancers. Secondary cancers are now being increasingly recognized as a complication among HSCT recipients. The magnitude of risk of secondary malignancies after HSCT has been found to be increased four‐fold to 11‐fold compared to the general population. The estimated actuarial incidence is reported to be about 3–4% at 10 years, increasing to 10–12 % at 15 years after allogeneic HSCT [13, 14, 49‐53].

Risk factors for the development of secondary malignancies include exposure to chemotherapy and radiation before transplantation, use of TBI and high‐dose chemotherapy used in preparation for HSCT, infection with viruses such as Ebstein‐Barr virus (EBV) and Hepatitis B and C viruses (HBV and HCV), immunodeficiency after transplant, aggravated by the use of immunosuppressive drugs for prophylaxis and treatment of GVHD, including the use of monoclonal and polyclonal antibodies, HLA non‐identity, and T‐cell depletion, the type of transplant (autologous versus allogeneic), the source of hematopoietic stem cells used, and the primary malignancy. However, assessment of risk factors for all secondary malignancies in aggregate is somewhat artificial because of the heterogeneous nature of the secondary malignancies, with differing clinico‐pathological features, distinct pathogenesis, and hence very distinct risk factors associated with their development [13, 14].

Currently secondary malignancies after HSCT are categorized into three distinct groups: 1) myelodysplasia and acute myeloid leukemia, 2) lymphoma, including lymphoproliferative disorders and 3) solid tumors.