Exploring the aftermath of hematopoietic cell transplantation: 18-year insights into post-transplant neoplasms

IntroductionSurvival post-hematopoietic stem cell transplantation (HCT) is improving, with an increasing number of survivors. Subsequent neoplasms (SNs) following HCTs are of particular concern.MethodsBetween January 2003 and December 2022, HCT recipients’ records were retrospectively reviewed.Resul...

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Main Authors: Rawad Rihani, Shrouq Amer, Khalid Halahleh, Hasan Hashem, Zaid Abdel Rahman, Laith Baqain, Mayada Abu Shanap, Iyad Sultan, Amr Qudeimat
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Oncology
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Online Access:https://www.frontiersin.org/articles/10.3389/fonc.2025.1589755/full
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author Rawad Rihani
Shrouq Amer
Khalid Halahleh
Hasan Hashem
Zaid Abdel Rahman
Laith Baqain
Mayada Abu Shanap
Iyad Sultan
Amr Qudeimat
author_facet Rawad Rihani
Shrouq Amer
Khalid Halahleh
Hasan Hashem
Zaid Abdel Rahman
Laith Baqain
Mayada Abu Shanap
Iyad Sultan
Amr Qudeimat
author_sort Rawad Rihani
collection DOAJ
description IntroductionSurvival post-hematopoietic stem cell transplantation (HCT) is improving, with an increasing number of survivors. Subsequent neoplasms (SNs) following HCTs are of particular concern.MethodsBetween January 2003 and December 2022, HCT recipients’ records were retrospectively reviewed.ResultsAt a median follow-up of 108 months (range, 0.13-215), 2659 patients received HCTs. Of those, 1131 (43%) were <18 years old. Allogeneic HCTs were conducted in 1476 (56%) patients. Myeloablative conditioning (MAC) was utilized in 2157 (81%), and 583(22%) received TBI. At a median of 9 years following transplant, forty-three patients developed SNs (1.6%) with a median age at time of HCT of 27.6 years (range, 2.8-64.8). Of those: 32 were males (74%), 20 received full HLA-matched allogeneic HCTs (46.5%), two (4.6%) had unrelated cord blood HCT (UCB), and one (2.3%) received haplo-HCT, whereas autologous HCTs accounted for 46.6% (n=20). Underlying diseases were: ALL(13.9%), AML(11.6%), Hodgkin Lymphoma(13.9%), Non-Hodgkin lymphoma(13.9%), Multiple Myeloma(18.6%), Fanconi Anemia(6.9%), CML(6.9%),Neuroblastoma(2.3%), and thalassemia (2.3%).); cGVHD occurred in (74%), and CMV infection/reactivation in (60.5%). Stem cell source included peripheral blood in (81.4%), BM in (3.9%), and UCB in (4.7%). Conditioning regimens were MAC (81.4%) vs RIC (18.6%). TBI-based regimen was utilized in 14 patients (32.5%). Subsequent hematologic malignancies accounted for 32.5% of SNs. While subsequent solid neoplasms occurred in 65.2%, and PTLD occurred in 2.3%. The probability of 5-year overall survival after a SN was 58.2%.ConclusionsSNs adversely impact the overall survival and quality of life of HCT survivors. In our cohort, the rate of post-HCT SNs was lower than that in the literature; however, longer follow-up of our cohort is needed.
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spelling doaj-art-6d61d440895c410186728ca892976c3a2025-08-20T03:08:32ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-07-011510.3389/fonc.2025.15897551589755Exploring the aftermath of hematopoietic cell transplantation: 18-year insights into post-transplant neoplasmsRawad Rihani0Shrouq Amer1Khalid Halahleh2Hasan Hashem3Zaid Abdel Rahman4Laith Baqain5Mayada Abu Shanap6Iyad Sultan7Amr Qudeimat8Department of Pediatrics, Blood and Marrow Transplantation and Cellular Therapy, King Hussein Cancer Center, Amman, JordanDepartment of Pediatrics, Blood and Marrow Transplantation and Cellular Therapy, King Hussein Cancer Center, Amman, JordanAdult Blood and Marrow Transplantation and Cellular Therapy Program, King Hussein Cancer Center, Amman, JordanDepartment of Pediatrics, Blood and Marrow Transplantation and Cellular Therapy, King Hussein Cancer Center, Amman, JordanAdult Blood and Marrow Transplantation and Cellular Therapy Program, King Hussein Cancer Center, Amman, JordanFaculty of Medicine, University of Jordan, Amman, JordanDepartment of Pediatrics, Blood and Marrow Transplantation and Cellular Therapy, King Hussein Cancer Center, Amman, JordanDepartment of Pediatrics, Blood and Marrow Transplantation and Cellular Therapy, King Hussein Cancer Center, Amman, JordanDepartment of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN, United StatesIntroductionSurvival post-hematopoietic stem cell transplantation (HCT) is improving, with an increasing number of survivors. Subsequent neoplasms (SNs) following HCTs are of particular concern.MethodsBetween January 2003 and December 2022, HCT recipients’ records were retrospectively reviewed.ResultsAt a median follow-up of 108 months (range, 0.13-215), 2659 patients received HCTs. Of those, 1131 (43%) were <18 years old. Allogeneic HCTs were conducted in 1476 (56%) patients. Myeloablative conditioning (MAC) was utilized in 2157 (81%), and 583(22%) received TBI. At a median of 9 years following transplant, forty-three patients developed SNs (1.6%) with a median age at time of HCT of 27.6 years (range, 2.8-64.8). Of those: 32 were males (74%), 20 received full HLA-matched allogeneic HCTs (46.5%), two (4.6%) had unrelated cord blood HCT (UCB), and one (2.3%) received haplo-HCT, whereas autologous HCTs accounted for 46.6% (n=20). Underlying diseases were: ALL(13.9%), AML(11.6%), Hodgkin Lymphoma(13.9%), Non-Hodgkin lymphoma(13.9%), Multiple Myeloma(18.6%), Fanconi Anemia(6.9%), CML(6.9%),Neuroblastoma(2.3%), and thalassemia (2.3%).); cGVHD occurred in (74%), and CMV infection/reactivation in (60.5%). Stem cell source included peripheral blood in (81.4%), BM in (3.9%), and UCB in (4.7%). Conditioning regimens were MAC (81.4%) vs RIC (18.6%). TBI-based regimen was utilized in 14 patients (32.5%). Subsequent hematologic malignancies accounted for 32.5% of SNs. While subsequent solid neoplasms occurred in 65.2%, and PTLD occurred in 2.3%. The probability of 5-year overall survival after a SN was 58.2%.ConclusionsSNs adversely impact the overall survival and quality of life of HCT survivors. In our cohort, the rate of post-HCT SNs was lower than that in the literature; however, longer follow-up of our cohort is needed.https://www.frontiersin.org/articles/10.3389/fonc.2025.1589755/fullhematopoietic cell transplantation (HCT)second cancerhematologic malignanciescancer survivorshuman leukocyte antigen (HLA)myeloablative conditioning (MAC)
spellingShingle Rawad Rihani
Shrouq Amer
Khalid Halahleh
Hasan Hashem
Zaid Abdel Rahman
Laith Baqain
Mayada Abu Shanap
Iyad Sultan
Amr Qudeimat
Exploring the aftermath of hematopoietic cell transplantation: 18-year insights into post-transplant neoplasms
Frontiers in Oncology
hematopoietic cell transplantation (HCT)
second cancer
hematologic malignancies
cancer survivors
human leukocyte antigen (HLA)
myeloablative conditioning (MAC)
title Exploring the aftermath of hematopoietic cell transplantation: 18-year insights into post-transplant neoplasms
title_full Exploring the aftermath of hematopoietic cell transplantation: 18-year insights into post-transplant neoplasms
title_fullStr Exploring the aftermath of hematopoietic cell transplantation: 18-year insights into post-transplant neoplasms
title_full_unstemmed Exploring the aftermath of hematopoietic cell transplantation: 18-year insights into post-transplant neoplasms
title_short Exploring the aftermath of hematopoietic cell transplantation: 18-year insights into post-transplant neoplasms
title_sort exploring the aftermath of hematopoietic cell transplantation 18 year insights into post transplant neoplasms
topic hematopoietic cell transplantation (HCT)
second cancer
hematologic malignancies
cancer survivors
human leukocyte antigen (HLA)
myeloablative conditioning (MAC)
url https://www.frontiersin.org/articles/10.3389/fonc.2025.1589755/full
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