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Vasudevan Nampoothiri R, Yeung J, Pierre A, Wong R, Darling G, Kim J, Siu LL, Chen E, Bouttell E, Knox J, Kim D(DH, Lipton JH. Outcomes of patients with esophageal cancer after allogeneic hematopoietic stem cell transplantation. J Gastrointest Oncol 2022; 13:2705-2712. [PMID: 36636086 PMCID: PMC9830323 DOI: 10.21037/jgo-22-700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background The improving survival in patients after allogeneic hematopoietic stem cell transplantation (aHCT) has warranted an increased attention to the long-term complications after aHCT especially second malignancies. The risk of developing esophageal cancer is thought to be higher than other malignancies after aHCT. There are limited data on the clinical characteristics, staging, treatment options and outcomes in these patients. Methods We retrospectively reviewed all patients who underwent aHCT at our centre over 30 years and identified patients who developed secondary esophageal cancer. Patients were analyzed for transplant details, disease characteristics and therapy, relapse free survival (RFS), and overall survival (OS). Results Ten patients [females 40% (n=4); median age 62 years] were diagnosed with esophageal cancer after a median duration of 5.8 years since aHCT. The standardized incidence ratio (SIR) for esophageal ca after aHCT was 1.96. Five patients (55.5%) had advanced clinical stages (stage III-IV) at diagnosis. Esophagectomy (with or without neoadjuvant chemotherapy) was performed in 50% (n=5) patients. Remission was achieved in 70% (n=7) of patients while 1 patient had progressive disease after planned treatment. Progressive disease was the cause in 50% (n=3) of deaths. Estimated 2- and 5-year overall survival after diagnosis of esophageal cancer was 60% and 45% respectively (median survival: 44.1 months). Conclusions Despite the higher risk and increased incidence of esophageal cancer after aHCT, the outcomes these patients may be comparable to that in general population if diagnosed early. This implies the need for continued long term follow-up for patients after aHCT with a transplant physician.
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Affiliation(s)
- Ram Vasudevan Nampoothiri
- Hans Messner Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Yeung
- Department of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pierre
- Department of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gail Darling
- Department of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lillian L. Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Bouttell
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Knox
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dennis (Dong Huan) Kim
- Hans Messner Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey H. Lipton
- Hans Messner Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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