Skin cancer risk after hematopoietic stem cell transplantation: a systematic review and meta‐analysis

• Published in: International journal of dermatology Vol. 63; no. 12; pp. 1691 - 1700
• Main Authors: Mansilla‐Polo, Miguel, López‐Davia, Javier, De Unamuno‐Bustos, Blanca, Martín‐Torregrosa, Daniel, Abril‐Pérez, Carlos, Ezzatvar, Yasmin, Botella‐Estrada, Rafael
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.12.2024
• Subjects: allogeneic transplant; Allografts; Autografts; autologous transplant; basal cell carcinoma; Cancer; Carcinoma, Basal Cell - epidemiology; Carcinoma, Basal Cell - etiology; cutaneous neoplasm; Female; Gender; Graft vs Host Disease - epidemiology; Graft vs Host Disease - etiology; Health risks; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Incidence; Irradiation; Male; Malignancy; melanoma; Meta-analysis; Risk Factors; Sex Factors; Skin cancer; Skin grafts; Skin Neoplasms - epidemiology; Skin Neoplasms - etiology; Squamous cell carcinoma; standardized incidence ratio; Statistical analysis; Stem cell transplantation; Stem cells; Transplantation; Transplantation, Autologous - adverse effects; Transplantation, Homologous - adverse effects; Transplants; Voriconazole; Voriconazole - adverse effects; Voriconazole - therapeutic use; Whole-Body Irradiation - adverse effects; autologous transplant; standardized incidence ratio; basal cell carcinoma; melanoma; allogeneic transplant; cutaneous neoplasm; squamous cell carcinoma
• ISSN: 0011-9059; 1365-4632; 1365-4632
• DOI: 10.1111/ijd.17371

Hematopoietic stem cell transplantation (HSCT) has improved outcomes for severe hematologic, malignant, and immune disorders, yet poses an increased risk of subsequent malignancies. This study aimed to examine the risk of skin cancer following HSCT and identify potential risk factors. The search was conducted in MEDLINE, EMBASE, and CINAHL databases until December 2023. Cohort studies reporting standardized incidence ratios (SIRs) for post‐HSCT skin cancer or investigating risk factors were included. SIRs, or hazard ratios (HRs) with 95% confidence interval (CI), were calculated using random‐effects inverse‐variance models. Outcome endpoints were SIRs of skin cancer post‐HSCT and risk factors, including gender, chronic graft‐versus‐host disease (cGVHD), voriconazole exposure, and total body irradiation (TBI). Twenty‐six studies involving 164,944 HSCT recipients (allogeneic HSCT, n = 68,637; autologous HSCT, n = 95,435; mean age: 38.5 ± 13.8 years; 71,354 females [43.3%]) were analyzed. Overall, SIR for skin cancer post‐HSCT was 7.21 (95% CI 3.98–13.08), with SIRs of 2.25 (95% CI: 1.37–3.68) for autologous HSCT, and 10.18 (95% CI 5.07–20.43) for allogeneic HSCT. Risk factors for skin cancer risk included cGVHD (HR = 2.86 [95% CI: 2.01–4.07]), specifically for basal cell and squamous cell carcinoma (SCC) (HR = 1.80 [95% CI: 1.31–2.46] and HR = 3.68 [95% CI: 2.39–5.68], respectively), male gender (HR = 1.56 [95% CI: 1.15–2.13]), especially for SCC (HR = 1.70 [95% CI: 1.03–2.80]), and voriconazole exposure (HR = 2.01 [95% CI: 1.12–3.61]). TBI showed no statistically significant association with subsequent skin cancer (HR = 1.12 [95% CI: 0.73–1.71]). These findings highlight the importance of rigorous skin cancer surveillance and preventive strategies in HSCT recipients, particularly in male individuals undergoing allogeneic transplants and those with identifiable risk factors, to enable early detection and intervention.