CT-312 Secondary Solid Tumor After Allogeneic Hematopoietic Stem Cell Transplantation: A Case Report

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 24; p. S601
• Main Authors: Hasanzade, Ulviyya, Koruk, Kıvanç, Ahmed, Melin, Tiryaki, Tarık Onur, Özbalak, Murat, Hindilerden, İpek Yönal, Nalçacı, Meliha
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-09-2024
• Subjects: acute myeloid leukemia; hematopoietic stem cell transplantation; myeloablative conditioning; secondary solid tumors; squamous cell carcinoma; hematopoietic stem cell transplantation; CT; acute myeloid leukemia; myeloablative conditioning; secondary solid tumors; squamous cell carcinoma
• ISSN: 2152-2650
• DOI: 10.1016/S2152-2650(24)01768-3

We present the case of a 56-year-old male diagnosed with acute myeloid leukemia (AML) 21 years ago. He underwent allogeneic hematopoietic stem cell transplantation (AHSCT) from an HLA-matched sibling donor. He has been in CR2 following the conditioning regimen busulfan/cyclophosphamide (BU/CY) plus short-term methotrexate and cyclosporin as graft-versus-host disease (GVHD) prophylaxis administered 19 years ago. He has had no complications with acute or chronic GVHD.
In January 2024, he developed massive ascites. Non-portal hypertension-type ascites was detected. The analysis of ascitic fluid was consistent with adenocarcinoma. Serum CA 19-9 and CA 125 levels were elevated suggesting gastrointestinal, biliary tract, or pancreatic tumor. PET scan was inconclusive to detect primary origin of the tumor. Further investigations including endoscopy, endoscopic ultrasound, and colonoscopy were planned.
Secondary solid tumors (SSTs) are a rare but well-defined late complication of AHSCT. SSTs occur in up to 15% of patients within 15 years of AHSCT with myeloablative conditioning, without reaching a plateau. The most common SSTs include squamous cell carcinoma of the skin, genitourinary tract, and oral cavity and lung and breast cancers. Risk factors of SSTs were reported as smoking, alcohol intake, and use of myeloablative-conditioning regimens. SSTs are common causes of nonrelapse mortality in long-term survivors and may account for up to 10% of late deaths. Cancer prevention guidelines are largely consensus driven and follow the recommendations for the general population. Here we report a case diagnosed with SST 19 years after AHSCT; a 30 pack-year history of smoking and use of myeloablative conditioning regimen were identified as risk factors.