根据一项新研究的结果，接受造血干细胞移植（HSCT）的患者将面临相当高的二次癌症风险，特别是对于那些接受移植时年龄较大和接受女性捐赠者干细胞的患者。这一结果将发表在2007年1月1日的《CANCER》上，文章表示异源HSCT移植在10年内的二次癌症风险是正常人群的2倍。 特别的，对于超过40岁的和接受女性捐赠干细胞的病人，这一风险为正常人的4倍。目前HSCT是治疗一系列特殊疾病的有效方法，如白血病或者血细胞异常（通常发生于患者骨髓）。这会破坏患者骨髓中的自有正常干细胞，而用捐赠者的干细胞进行替代为治愈这些疾病带来了希望，比非移植治疗的死亡率要低得多。但是尽管能拯救患者，这些治疗会带来短期的副作用，包括感染，肝血管阻塞等，同时还可能存在长期的癌症威胁。 为了评估风险以及找到相关的影响因子，British??Columbia大学的Genevieve Gallagher和DonnaL.Forrest医学博士查看了过去926名18岁以上接受移植病人的医疗记录。他们发现，这些病人的术后10年二次癌症发病率是3.1%,排除了非黑素癌和宫颈癌后，这一数字是2.3%。这是正常人群的1.85倍。诊断的中值是移植后7年，最常见的癌症是皮肤癌（鳞状上皮），肺部，口腔等癌症。 他们还发现，在40岁后接受移植的患者风险是正常人3倍以上，而接受女性捐赠的病人风险几乎是正常人的4倍，如果接受移植的是男性则这一风险还会更高。
英文原文：
Long-term cancer risk follows stem cell transplant recipients
Hematopoietic stem cell transplant (HSCT) recipients face a significant long-term risk for developing a second cancer, particularly if they were older at the time of transplant or received stem cells from a female donor, according to a new study. Published in the January 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals that within 10 years of an allogeneic HSCT, the relative risk of a second, solid cancer is almost twice that of the general population. In addition, cancer risk almost quadruples for patients who were over 40 years old at the time of transplant or for patients who received stem cells from a female donor.
Myeloablative, allogeneic HSCT is an effective standard therapy for specific life-threatening diseases, such as leukemia or myelodysplastic syndrome, for which blood cell lineages (which originate principally in the bone marrow and circulate in the blood) are abnormal. Destroying the patient's own unhealthy stem cells in the bone marrow and replacing them with a compatible donor's stem cells offers the chance of cure for a disease that otherwise has a high mortality rate with non-transplant therapies. While the procedure can be lifesaving, it is associated with serious short-term adverse effects, such as mucostitis, infections, and liver vascular obstruction as well as the potential long-term complication of developing of a second, usually solid cancer.
To estimate the risk and identify risk factors associated with this outcome, Genevieve Gallagher, M.D. and Donna L. Forrest, M.D. of the BC Cancer Agency and the University of British Columbia, retrospectively reviewed the medical records of 926 patients treated with myeloablative stem cell transplants over an 18-year period.
They found that at their institution the 10-year incidence of second cancers in these patients was 3.1 percent. When nonmelanoma skin cancer and carcinoma in situ of the cervix were excluded, incidence was 2.3 percent. That risk was 1.85 times that of the general population. The median time to diagnosis was almost 7 years after transplant. The most commonly reported second cancers were cancers of the skin (basal and squamous cell), lung, oral cavity, and colon.
Furthermore, data analysis showed that the risk more than tripled for patients who received their transplant when they were over 40 years of age. The study also identified a new risk factor: patients who received stem cells from a female donor had almost quadrupled the risk of a second solid cancer, a risk that further increased when the patient was male. "This observation has not been previously reported in the literature and the explanation for this finding is uncertain," say the authors.
"Since the risk of developing a solid neoplasm post-allogeneic transplantation continues to increase with time," suggest the authors, "extended follow-up will be needed to more fully assess the incidence and risk factors for their development."
摘自《生物谷》 |
