Incidence of and Risk Factors for Cutaneous Malignant Neoplasms After Blood or Marrow Transplant.

IF 11.5 1区医学 Q1 DERMATOLOGY

JAMA dermatology Pub Date : 2024-12-18 DOI:10.1001/jamadermatol.2024.5129

Kristy K Broman, Qingrui Meng, Anna Holmqvist, Nora Balas, Joshua Richman, Wendy Landier, Lindsey Hageman, Elizabeth Ross, Alysia Bosworth, Hok Sreng Te, Britany Hollenquest, F Lennie Wong, Ravi Bhatia, Stephen J Forman, Saro H Armenian, Daniel J Weisdorf, Smita Bhatia

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引用次数: 0

Abstract

Importance: Cutaneous malignant neoplasms are the most common subsequent neoplasm after blood or marrow transplant (BMT), but a full assessment among survivors is lacking.

Objective: To identify risk factors for subsequent cutaneous malignant neoplasms using the BMT Survivor Study (BMTSS).

Design, setting, and participants: This retrospective cohort study included patients who underwent transplant from 1974 to 2014 at City of Hope, University of Minnesota, or University of Alabama at Birmingham and survived 2 years or longer, as well as a comparison cohort of siblings. Both groups completed the BMTSS survey. Data analysis took place from October 2022 to October 2024.

Exposures: Demographics, pre-BMT and BMT-related therapeutic exposures, chronic graft-vs-host disease (cGVHD), and posttransplant immunosuppression.

Main outcomes and measures: Incident cutaneous malignant neoplasms (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], and melanoma) after BMT. Exposures were evaluated for association with subsequent neoplasms using proportional subdistribution hazards models (reported as subdistribution hazard ratio [SHR] and 95% CI).

Results: Among the 3880 BMT survivors (median [range] age at BMT, 44.0 [0-78.0] years; 2165 [55.8%] male; 190 [4.9%] Black, 468 [12.1%] Hispanic, 2897 [74.7%] non-Hispanic White, and 325 [8.4%] of other race [including Asian and Pacific Islander] and multiracial) who were followed up for a median (range) of 9.5 (2.0-46.0) years, 605 developed 778 distinct cutaneous neoplasms (BCC, 321; SCC, 231; melanoma, 78; and unknown type, 148). The 30-year cumulative incidence of any cutaneous malignant neoplasm was 27.4% (BCC, 18.0%; SCC, 9.8%; and melanoma, 3.7%). Seventy-year cumulative probabilities of BCC, SCC, and melanoma were considerably higher in BMT survivors than siblings (18.1% vs 8.2%, 14.7% vs 4.2%, and 4.2% vs 2.4%, respectively). Among BMT survivors, risk factors for subsequent cutaneous malignant neoplasms included age of 50 years and older at BMT (BCC: SHR, 1.76; 95% CI, 1.36-2.29; SCC: SHR, 3.37; 95% CI, 2.41-4.72), male sex (BCC: SHR, 1.39; 95% CI, 1.10-1.75; SCC: SHR, 1.85; 95% CI, 1.39-2.45), pre-BMT monoclonal antibody exposure (BCC: SHR, 1.71; 95% CI, 1.27-2.31), allogeneic BMT with cGVHD (BCC: SHR, 1.48; 95% CI, 1.06-2.08; SCC: SHR, 2.61; 95% CI, 1.68-4.04 [reference: autologous BMT]), post-BMT immunosuppression (BCC: SHR, 1.63; 95% CI, 1.24-2.14; SCC: SHR, 1.48; 95% CI, 1.09-2.02; melanoma: SHR, 1.90; 95% CI, 1.16-3.12), and transplant at City of Hope (BCC: SHR, 3.55; 95% CI, 2.58-4.89; SCC: SHR, 3.57; 95% CI, 2.34-5.47 [reference: University of Minnesota]) or University of Alabama at Birmingham (BCC: SHR, 2.35; 95% CI, 1.35-4.23; SCC: SHR, 2.63; 95% CI, 1.36-5.08 [reference: University of Minnesota]). Race and ethnicity other than non-Hispanic White were protective for BCC (Black: no cases; Hispanic: SHR, 0.27; 95% CI, 0.16-0.44; other race and multiracial: SHR, 0.26; 95% CI, 0.14-0.50 [reference: non-Hispanic White]) and SCC (Black: SHR, 0.17; 95% CI, 0.04-0.67; Hispanic: SHR, 0.28; 95% CI, 0.16-0.50; other race and multiracial: SHR, 0.13; 95% CI, 0.05-0.37 [reference: non-Hispanic White]). Total body irradiation was associated with BCC risk among those younger than 50 years at BMT (SHR, 1.92; 95% CI, 1.27-2.92).

Conclusions and relevance: In this cohort study, the high risk of cutaneous malignant neoplasms and malignant-specific risk factors suggest a need for personalized patient counseling and posttransplant dermatologic surveillance.

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血液或骨髓移植后皮肤恶性肿瘤的发生率及危险因素分析。

重要性：皮肤恶性肿瘤是血液或骨髓移植（BMT）后最常见的继发肿瘤，但缺乏对幸存者的全面评估。目的：通过BMT幸存者研究（BMTSS）确定继发皮肤恶性肿瘤的危险因素。设计、环境和参与者：这项回顾性队列研究包括1974年至2014年在希望之城、明尼苏达大学或阿拉巴马大学伯明翰分校接受移植并存活2年或更长时间的患者，以及兄弟姐妹的比较队列。两组都完成了BMTSS调查。数据分析时间为2022年10月至2024年10月。暴露：人口统计学、移植前和移植相关的治疗暴露、慢性移植物抗宿主病（cGVHD）和移植后免疫抑制。主要结局和指标：BMT后皮肤恶性肿瘤（基底细胞癌[BCC]、鳞状细胞癌[SCC]和黑色素瘤）的发生率。使用比例亚分布风险模型（报告为亚分布风险比[SHR]和95% CI）评估暴露与后续肿瘤的关系。结果：3880例BMT幸存者(BMT时的中位[范围]年龄为44.0[0-78.0]岁；男性2165例[55.8%]；黑人190例（4.9%），西班牙裔468例（12.1%），非西班牙裔白人2897例（74.7%），其他种族（包括亚洲和太平洋岛民）325例（8.4%），随访时间中位数（范围）为9.5年（2.0-46.0年），605例发生778例不同的皮肤肿瘤(BCC， 321例；鳞状细胞癌,231;黑色素瘤,78;和未知类型，148)。任何皮肤恶性肿瘤的30年累积发病率为27.4% (BCC, 18.0%；鳞状细胞癌,9.8%;黑色素瘤，3.7%)。BMT幸存者患BCC、SCC和黑色素瘤的70年累积概率明显高于兄弟姐妹（分别为18.1%对8.2%，14.7%对4.2%，4.2%对2.4%）。在BMT幸存者中，继发皮肤恶性肿瘤的危险因素包括年龄在50岁及以上的BMT患者(BCC: SHR, 1.76；95% ci, 1.36-2.29；Scc: shr, 3.37；95% CI, 2.41-4.72)，男性(BCC: SHR, 1.39；95% ci, 1.10-1.75；Scc: shr, 1.85；95% CI, 1.39-2.45)， bmt前单克隆抗体暴露(BCC: SHR, 1.71；95% CI, 1.27-2.31)，同种异体BMT合并cGVHD (BCC: SHR, 1.48；95% ci, 1.06-2.08；Scc: shr, 2.61；95% CI, 1.68-4.04[文献：自体BMT])， BMT后免疫抑制(BCC: SHR, 1.63；95% ci, 1.24-2.14；Scc: shr, 1.48；95% ci, 1.09-2.02；黑色素瘤：SHR为1.90；95% CI, 1.16-3.12)，并在City of Hope移植(BCC: SHR, 3.55；95% ci, 2.58-4.89；Scc: shr, 3.57；95% CI, 2.34-5.47[参考文献：明尼苏达大学])或阿拉巴马大学伯明翰分校(BCC: SHR, 2.35；95% ci, 1.35-4.23；Scc: shr, 2.63；95% CI, 1.36-5.08[文献来源：明尼苏达大学])。非西班牙裔白人以外的种族和民族对BCC有保护作用(黑人：无病例；西班牙裔：SHR， 0.27；95% ci, 0.16-0.44；其他种族和多种族：SHR， 0.26；95% CI, 0.14-0.50[参考文献：非西班牙裔白人])和SCC(黑人：SHR， 0.17；95% ci, 0.04-0.67；西班牙裔：SHR， 0.28；95% ci, 0.16-0.50；其他种族和多种族：SHR， 0.13；95% CI, 0.05-0.37[参考文献：非西班牙裔白人])。在50岁以下的BMT患者中，全身照射与BCC风险相关(SHR, 1.92；95% ci, 1.27-2.92)。结论和相关性：在这项队列研究中，皮肤恶性肿瘤的高风险和恶性特异性危险因素表明需要个性化患者咨询和移植后皮肤病学监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA dermatology DERMATOLOGY-

CiteScore

14.10

自引率

5.50%

发文量

300

期刊介绍： JAMA Dermatology is an international peer-reviewed journal that has been in continuous publication since 1882. It began publication by the American Medical Association in 1920 as Archives of Dermatology and Syphilology. The journal publishes material that helps in the development and testing of the effectiveness of diagnosis and treatment in medical and surgical dermatology, pediatric and geriatric dermatology, and oncologic and aesthetic dermatologic surgery. JAMA Dermatology is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications. It is published online weekly, every Wednesday, and in 12 print/online issues a year. The mission of the journal is to elevate the art and science of health and diseases of skin, hair, nails, and mucous membranes, and their treatment, with the aim of enabling dermatologists to deliver evidence-based, high-value medical and surgical dermatologic care. The journal publishes a broad range of innovative studies and trials that shift research and clinical practice paradigms, expand the understanding of the burden of dermatologic diseases and key outcomes, improve the practice of dermatology, and ensure equitable care to all patients. It also features research and opinion examining ethical, moral, socioeconomic, educational, and political issues relevant to dermatologists, aiming to enable ongoing improvement to the workforce, scope of practice, and the training of future dermatologists. JAMA Dermatology aims to be a leader in developing initiatives to improve diversity, equity, and inclusion within the specialty and within dermatology medical publishing.