Malignant Tumors Occurring after Treatment of Aplastic Anemia

作者：Gèrard Socié, Michel Henry-Amar, Andrea Paolo Bacigalupo, Jill Hows, André Tichelli, Per T Ljungman, Shaun R. McCann, Norbert Frickhofen, E. T. van’t Veer-Korthof, Éliane Gluckman · 发表于：New England Journal of Medicine · 年份：1993 · DOI：10.1056/nejm199310143291603 · 被引用次数：470 · 研究领域：Hematopoietic Stem Cell Transplantation、Acute Myeloid Leukemia Research、Neutropenia and Cancer Infections

BACKGROUND AND METHODS: Recent studies have shown that long-term survivors of acquired aplastic anemia may be at high risk for malignant diseases. We assessed the risk of cancer after aplastic anemia was treated with immunosuppression or bone marrow transplantation and sought to identify risk factors according to treatment. The study population consisted of 860 patients treated by immunosuppression and 748 patients who had received bone marrow transplants for the treatment of severe aplastic anemia. The risk of cancer was analyzed overall and according to treatment relative to the risk in the general population. In calculating relative risk, we excluded patients with myelodysplastic syndromes or acute leukemias arising less than 6 months after treatment, and solid cancers arising less than 12 months after treatment, because of a possible association with aplastic anemia itself rather than with the treatment received. RESULTS: Forty-two malignant conditions were reported in the 860 patients who received immunosuppressive therapy: 19 cases of myelodysplastic syndrome, 15 cases of acute leukemia, 1 case of non-Hodgkin's lymphoma, and 7 solid tumors. Nine were reported in the 748 patients who received bone marrow transplants: two cases of acute leukemia and seven solid tumors. After the exclusions listed above, the overall relative risk of cancer was 5.50 (P < 0.001) as compared with that in the general European population; the risk was 5.15 (P < 0.001) after immunosuppressive th...