@article{b798430bc6984217a5f570bb3f06adff,
title = "Use of azathioprine for graft-vs-host disease is the major risk for development of secondary malignancies after haematopoietic stem cell transplantation: A nationwide population-based study",
abstract = "Background: As more patients are treated by haematopoietic stem cell transplantation (HSCT), development of secondary malignancy (SM) becomes an increasingly common issue in long-term survivors. Methods: We conducted a nationwide population-based study of the Taiwanese population to analyse patients who received HSCT between January 1997 and December 2010. Standardised incidence ratios (SIRs) were used to compare the risk of SM in HSCT patients and the general population. Multivariate analysis was performed to identify independent predictors of SM. Results: Patients receiving HSCT had a significantly greater risk of developing SM (SIR 2.00; 95% confidence interval (CI) 1.45-2.69; P<0.001). Specifically, the incidence increased for cancers of the oral cavity (SIR 14.18) and oesophagus (SIR 14.75) after allogeneic HSCT. Multivariate analysis revealed an increased SIR for cancer in patients who received the immunosuppressant azathioprine. The risk of SM also increased with greater cumulative doses of azathioprine. Conclusions: This study demonstrates an increased incidence of SM in Taiwanese patients who received allogeneic HSCT, especially for cancers of the oral cavity and oesophagus. This finding is different from results in populations of Western countries. Physicians should be cautious about azathioprine use for graft-vs-host disease after HSCT.",
keywords = "cancer risk, epidemiology, haematopoietic stem cell transplantation, population study, secondary malignancy",
author = "Chien, {S. H.} and Liu, {C. J.} and Hong, {Y. C.} and Teng, {C. J.} and Hu, {Y. W.} and Shen, {C. C.} and Ku, {F. C.} and Chen, {S. C.} and Yeh, {C. M.} and Chiou, {T. J.} and Gau, {J. P.} and Tzeng, {C. H.}",
note = "Funding Information: This study is supported by grants from Taipei Veterans General Hospital (V103B-022, V102C-202, and V103E10-001). The study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of Bureau of National Health Insurance, Department of Health or National Health Research Institutes. Miss Chiu-Mei Yeh contributed significantly to the calculations and interpretations of statistical analyses in this study. Publisher Copyright: {\textcopyright} 2015 Cancer Research UK.",
year = "2015",
month = jan,
doi = "10.1038/bjc.2014.523",
language = "English",
volume = "112",
pages = "177--184",
journal = "British Journal of Cancer",
issn = "0007-0920",
publisher = "Springer Nature",
number = "1",
}
