Secondary Cancers after Transplant

The risk of getting a secondary cancer after a bone marrow or stem cell transplant is four to 11-fold higher than the general population. Lifelong screening for secondary cancers is essential.

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Secondary cancers are cancers that occur several months or years after transplant. They are different cancers than the one for which the transplant was performed. 

There are three types of secondary cancers that can occur after transplant:

  • therapy-related blood cancers, such as acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS)
  • lymphomas, primarily post-transplant lymphoproliferative disorder (PTLD)
  • solid tumors, such as breast, colon, skin or cervical cancer

The risk for developing each type of cancer depends on the type of transplant the patient received - whether it was an autologous transplant, using the individual's own blood stem cells, or an allogeneic transplant, using someone else's blood stem cells.

Screening for secondary cancers and choosing a healthy lifestyle can lower the risk of developing a secondary cancer.

Leukemia and Myelodysplastic Syndrome (MDS)

Acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) occasionally occur early after transplant in patients who were transplanted with their own stem cells (autologous transplant). The risk tapers off after five years..

The risk is highest among patients who:

  • received certain types of chemotherapy before or during transplant, such as etoposide 
  • had total body irradiation

Routine blood tests can screen for leukemia and MDS.


A lymphoma called post-transplant lymphoproliferative disorder (PTLD) occurs almost exclusively in patients who were transplanted with donor cells (allogeneic transplant).If it occurs, it tends to occur early after transplant, not later.

Risk factors include:

  • T-cells removed from the donor cells
  • umbilical cord blood transplant
  • diagnosis of immune deficiency disease
  •  unrelated or mismatched donor
  • graft-versus-host disease

The good news is that detection and treatment of PTLD has improved considerably over the years, and doctors are often able to prevent a full-blown lymphoma from forming.

Solid Tumors after Transplant

Solid tumors such as breast, colon, skin, and cervical cancer occur in two-five percent of patients after a bone marrow or stem cell transplant. The risk of developing a solid tumor increases over time, and is slightly higher in patients who had a transplant using donor cells (allogeneic transplant). Other risk factors include:

  • radiation as part of the conditioning regimen
  • chronic graft-versus-host disease (GVHD)
  • infection with certain viruses such as the human papilloma virus (HPV)

Preventing Cancer after Transplant

The first step in reducing the risk of developing a second cancer after a bone marrow transplant is to know your risks.

Routine annual screenings for cancer are important since problems detected early are often easier to treat than those found later.

Screening guidelines for transplant survivors are similar to what is recommended for the general population. However, women who received radiation to the chest should have a mammogram at age 25 or eight years after transplant, whichever comes earlier, and no later than age 40.

Lifestyle changes such as eating a healthy diet, exercise, and not smoking can also reduce your risk of developing a second cancer after transplant.

Watch a video about secondary cancers after a bone marrow or stem cell transplant.

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Next Page: Late Effects of a Pediatric Transplant

Updated August, 2023