Bone marrow transplants (BMT) can be used to treat AML with a reported 65% survival rate. More than 3,500 allogeneic transplants are performed in the United States each year. BMT replaces the unhealthy blood-forming cells (stem cells) with healthy ones. 

In a recent study reported by JAMA Oncology, research found that BMT “was associated with an increased risk of subsequent malignant neoplasms of the gastrointestinal (GI) tract.” Early detection is necessary due to the aggressive nature of these GI cancers. This study involved 6,710 patients who lived at least 2 years after their BMT. 

The study revealed that various types of GI cancer were more likely among BMT recipients. The specific types of GI cancer that was shown to be more common included liver, esophageal, pancreatic, gastric and colorectal cancer.

“Among the most common diagnoses in BMT recipients were non-Hodgkin lymphoma, acute myeloid leukemia or myelodysplastic syndrome, and plasma cell dyscrasias. Median age at BMT was 46 years.” 148 of the study's 3,266 participants developed cancer in the GI tract at a median time of 8.9 years after BMT.

Certain Exposures Increased GI Cancer Risk

• Exposure to cytarabine was associated with an increased risk of colorectal cancer
• Exposure to anthracyclines prior to a BMT was associated with the risk of liver cancer when compared to those who received no exposure
• Allogeneic BMT recipients with chronic graft-vs-host disease were at a 9.9 fold increased risk for esophageal cancer compared to autologous BMT recipients

The researcher concluded,

“The findings of this cohort study are relevant for oncologists and non oncologists (primary care doctors and specialists) who care for the growing number of transplant survivors. Awareness of subgroups of survivors of BMT at high risk for specific types of subsequent malignant neoplasms in the GI tract may influence recommendations regarding modifiable risk factors, as well as individualized screening.”

Because recommednations to screen for GI cancers in BMT survivors are currently not well developed, it's important for patients to be aware of this increased risk so they can have conversations about screening with their medical team. Conversations around GI cancer risk in the post-BMT population can help doctors to perform appropriate tests to make correct diagnosis, and may influence recommednations regarding additional risk factors that contribute to GI cancers such as smoking, alcohol use and eating patterns. If you have had a transplant, speak with your doctor about this study and what it should mean for your future GI cancer screenings.