Impact of prior solid tumor on outcomes of hematopoietic stem cell transplantation for hematologic malignancies: a propensity score-matched study.
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BACKGROUND: The Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) assigns a high-risk score to patients who develop secondary hematologic malignancies following solid tumors, indicating an increased risk of non-relapse mortality (NRM). This study aimed to evaluate the impact of prior solid tumors on outcomes after hematopoietic stem cell transplantation (HSCT). METHODS: From a cohort of 2,382 patients who underwent HSCT for acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), or myelodysplastic syndrome (MDS) between January 2014 and July 2024, we included 43 (1.8%) with a history of prior solid tumors and 82 matched controls for analysis by 1:2 propensity score matching. RESULTS: The solid tumor cohort predominantly comprised breast cancer (48.8%). With a median follow-up of 31.0 months, only one patient exhibited post-transplant relapse or metastasis of the solid tumor. Compared to the control group, patients with solid tumors exhibited higher ECOG scores (≥ 2: 23.1% vs. 9.5%, P = 0.049), lower platelet counts (35.5 vs. 72×109/L, P = 0.010), a higher incidence of complex karyotypes (16.3% vs. 3.7%, P = 0.031). No significant differences were noted in 3-year overall survival (OS) (64.3% vs. 71.9%, P = 0.468), leukemia-free survival (LFS) (57.6% vs. 70.8%, P = 0.218), graft-versus-host disease/relapse-free survival (GRFS) (43.3% vs. 53.0%, P = 0.359) and NRM (23.9% vs. 11.7%, P = 0.246). In an exploratory landmark analysis, the solid tumor cohort appeared to have significantly lower OS (P = 0.030), LFS (P = 0.009), and GRFS (P = 0.038) from 2 years after transplantation. Multivariable analysis identified age greater than 55 years, baseline platelet counts less than 50×109/L as significant predictors of inferior OS and LFS in solid tumor patients. CONCLUSION: Patients with hematologic diseases secondary to solid tumors showed no significant increase in overall transplantation risk. However, their adverse clinical characteristics and reduced long-term survival rates beyond 2 years post-transplantation, underscore the need to refine HCT-CI scoring and improve management strategies.