Marrow transplant survivors: simple clinical data separated high from low skin cancer risk

Design

Prognostic model development with internal validation, multicentre survivor cohort

Population

3448 survivors of autologous or allogeneic marrow transplant at three US centres

Primary outcome

Incident basal cell carcinoma, squamous cell carcinoma or melanoma

Effect

AUC 0.81 (BCC), 0.90 (SCC), 0.83 (melanoma); 15-year SCC 13.6% high vs 3.2% low risk

A prognostic study of 3448 people who had survived at least two years after blood or marrow transplant at three US centres built risk models from routine information: age at transplant, sex, ethnicity, prior skin cancer, pre-transplant monoclonal antibodies, total body irradiation, chronic graft-versus-host disease and post-transplant immunosuppression.

Over follow-up, 8.2% developed basal cell carcinoma, 5.3% squamous cell carcinoma and 2.1% melanoma. Model discrimination at 15 years was high (AUC 0.81 for basal cell, 0.90 for squamous cell, 0.83 for melanoma). Fifteen-year squamous cell carcinoma incidence was 13.6% in the high-risk group against 3.2% in the low-risk group; melanoma 4.4% against 0.8%.

The models were validated within the same cohort, not in an independent one, and outcomes partly relied on self-report. They still point clearly to the patients who most need regular skin examination.

• Ask every marrow transplant survivor about prior skin cancer, total body irradiation and chronic graft-versus-host disease.
• Offer regular full skin examination to survivors with chronic graft-versus-host disease or ongoing immunosuppression.
• Counsel survivors on sun protection and self-examination, since squamous cell risk was highest.
• Coordinate surveillance with the transplant team rather than relying on the survivor to self-refer.

Why it matters

Survivors are often discharged from transplant follow-up into general care, where skin cancer risk is easily forgotten.

Don't overread it

The models were validated within the same cohort, not in an independent population, and skin cancer was partly self-reported.

The statistics, in plain English

An AUC of 0.90 means the model ranked a patient who developed squamous cell carcinoma above one who did not nine times in ten. Cumulative incidence of 13.6% at 15 years means roughly one in seven high-risk survivors developed it in that time.

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