Secondary risk of developing a malignancy following HCT and

Secondary cancers: Secondary
malignancies including post-transplant lymphoproliferative disorder (PTLD),
myelodysplasia (MDS), acute myeloid leukemia (AML), and solid tumors are
well established complicationsin long-term HCT survivors. Risk factors
associated with the development of secondary cancers include genetic
predispositions of patient to develop cancer, older age at the time of
transplant, use of TBI, chronic GVHD, and prolonged immunosuppressive therapy. MDS,
AML and PTLD develop relatively early in the post-transplant period. Solid
tumors have a longer latency time. Survivors of HCT have a 2 to
3-fold increased risk of developing subsequent solid cancers compared with the general
population. Large retrospective
series have estimated the cumulative incidence rates of secondary solid tumors
at 1 to 2 percent at 10 years and 3 to 5 percent at 20 years after allogeneic
HCT. Cancers that occur at increased frequency include skin cancers (squamous
cell, basal cell, and malignant melanoma), cancers of the buccal cavity, liver,
central nervous system, thyroid, bone, and connective tissue. Therefore, it
is important to notify HCT survivors regarding an increased risk of
developing a malignancy following HCT and encourage in healthy behaviors
(healthy diet, exercise, smoke cessation) and encourage report of any
concerning symptoms. It is also important to encourage patients to reduce sun
exposure through use of high SPF sunscreens or skin coverage. In addition to a
routine physical examination, annual complete skin examination and dental
evaluation to monitor for the development of skin and oral cancers is
recommended.  More frequent oral
examination is required in patients with chronic GVHD, oral mucosal lichenoid
lesions, and/or a history of Fanconi’s anemia.
 Female HCT survivors screening for breast cancer should start at age 40
years. For patients who have received total body or chest irradiation, breast
cancer screening begins eight years after radiation or at age 25 years,
whichever occurs later.  Routine
age-appropriate cancer surveillance for other secondary malignancies should
follow the recommendations outlined under the General Health and Preventive
Screening section.