Increased risk of cervical dysplasia in long-term survivors of allogeneic stem cell transplantation--implications for screening and HPV vaccination.
As more women survive allogeneic stem cell transplantation (SCT), the development of genital human papilloma virus (HPV)-related squamous intraepithelial lesions (SIL) warrants study. Thirty-five of 38 females followed prospectively long-term after SCT for hematological malignancies (median: 7 years posttransplant) were adults and had cervical cytology testing. Acute graft-versus-host-disease (aGVHD) occurred in 9 and chronic (cGVHD) in 34 patients. Six (17%) continued receiving systemic immunosuppressive therapy (IST) for cGVHD >3 years after SCT. Of 15 (43%) with abnormal cytology, 12 (34%) patients had HPV-related SIL (median time to SIL 51 months, range: 22-108) including high-grade SIL in 7 (20%). Patients requiring continued IST had the highest risk (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.1-16.4; P = .019). This high incidence of SIL in long-term SCT survivors underscores the importance of gynecologic assessment after transplantation, especially in those requiring IST. This may portend an increased risk of genital or other HPV-related malignancies.
Savani
Bipin N
BN
Stem Cell Transplantation Section, Hematology Branch, NHLBI, National Institutes of Health, Bethesda, Maryland; Veterans Affairs Medical Center and Vanderbilt University Transplant Program, Nashville, Tennessee.
Stratton
Pamela
P
Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Shenoy
Aarthi
A
Stem Cell Transplantation Section, Hematology Branch, NHLBI, National Institutes of Health, Bethesda, Maryland.
Kozanas
Eleftheria
E
Stem Cell Transplantation Section, Hematology Branch, NHLBI, National Institutes of Health, Bethesda, Maryland.
Goodman
Stacey
S
Veterans Affairs Medical Center and Vanderbilt University Transplant Program, Nashville, Tennessee.
Barrett
A John
AJ
Stem Cell Transplantation Section, Hematology Branch, NHLBI, National Institutes of Health, Bethesda, Maryland. Electronic address: barrettj@nhlbi.nih.gov.
D000208:Acute Disease; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy; D006801:Humans; D015994:Incidence; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D011446:Prospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous; D002578:Uterine Cervical Dysplasia / Q000401:mortality* / Q000517:prevention & control; D014611:Vaccination
D053918:Papillomavirus Vaccines