Risk For G.I. Cancers After Blood Or Marrow Transplants

Blood or marrow transplants (BMT) can be used to treat MDS patients with a reported 65% survival rate. BMT’s can often lead to curable results. 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. Disease recurrence after a blood or marrow transplant is possible. This relapse is often difficult to treat.

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 blood or marrow transplant.

Elevated cancer risks among BMT recipients:

• Liver: 8.1 %
• Esophageal: 7.8%
• Pancreatic: 4.9%                
• Gastric: 3.1%
• Colorectal: 2.1%

“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 patients developed malignant neoplasms in the GI tract at a median of 8.9 years after BMT.

• 3,444 patients received autologous BMT (the stem cells come from the same person who will receive the transplant. The patient is their own donor).
• 3,266 patients received allogeneic BMT (the stem cells come from a person other than the patient. Matched related or unrelated donor). These transplant patients had a higher risk of malignant GI cancers.
• 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.
• Chronic graft-vs-host disease increased the risk for esophageal cancer.

The research concluded, “The findings of this cohort study are relevant for oncologists and non oncologists who care for the growing number of survivors of transplant. 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.”