Paper: Extensive Chronic Graft-Versus-Host-Disease Significantly Increases the Risk of Severe and Multifocal Genital Tract HPV Disease in Long-Term Survivors of Allogeneic Stem Cell Transplantation

Clinical Allogeneic and Autologous Transplantation: Late Complications and Approaches to Disease Recurrence
Oral and Poster Abstracts
723. Clinical Allogeneic and Autologous Transplantation: Late Complications and Approaches to Disease Recurrence: Poster I

Hall A, Level 2 (Orange County Convention Center)

Dana L Shanis, MD¹^*, Prathima Anandi, MD²^*, Caitlin Grant¹^*, Priyanka A Pophali, MD³, Eleftheria Koklanaris⁴^*, Bipin N. Savani, MD⁵, Austin John Barrett, MD, FRCP, FRCPath², Minoo Battiwalla, MD, MS² and Pamela Stratton, MD¹^*

¹NICHD, NIH, Bethesda, MD
²Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
³Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
⁴NHLBI, NIH, Bethesda, MD
⁵Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN

Background: High rates of cervical HPV disease in women after allogeneic stem cell transplantation (SCT) have been reported, but risk factors related to severe, multifocal, including vaginal and vulvar, HPV disease are not defined.

Objective: To determine rates and risk factors for multifocal and severe HPV disease in post-transplant women.

Methods: In a prospective long-term study after SCT, gynecologic history and assessment, cervical cytology and HPV testing were obtained with follow-up colposcopy and surgery as indicated for abnormal results. Prior HPV disease, genital graft-versus-host-disease (gGVHD), chronic GVHD (cGVHD) and immunosuppression treatment (IST) >3years were assessed for their association with extent and severity of genital HPV disease. Logistic regressions were used for multivariate analysis.

Results: Sixty five long term (>3 year) SCT survivors were studied prospectively on protocol. Patients received allogeneic transplantation from HLA-identical sibling donors with most undergoing myeloablative total body irradiation (94%) and T lymphocyte-depleted peripheral blood stem cells in 91% Of 65 women, 62 had gynecologic assessment with 8 (13%) having prior history of HPV disease; 16 (26%) had gGVHD. 20 women (32%) had acute GVHD, 46 (74%) had cGVHD; extent was limited in 23(37%) and extensive in 23(37%). 26(42%) had cGVHD requiring IST >3years. Of 21(34%) women with HPV disease after transplant, 12 required surgery and 7 had multifocal disease. Extensive chronic GVHD (but not acute GVHD) was found to significantly impact occurrence (OR=3.5, p=0.038), high-grade severity (OR=7.1, p=0.024) or multifocal HPV disease (OR=14.6, p=0.017).

Conclusion: Women who have undergone SCT have an increased risk of genital HPV disease, with highest rates in women with extensive cGVHD. Likely as a result of chronic immune dysregulation and the temporal nature of HPV, these women are at high risk of severe, multifocal disease, which if untreated may progress to genital cancer. Thus, gynecologic assessment as well as possible post-transplant HPV vaccination are critical aspects of care for women with significant GVHD post-transplant.

Support: Intramural programs of NHLBI, Clinical Center and NICHD, NCT00106925

Disclosures: Stratton: Allergan: Research Funding .

See more of: 723. Clinical Allogeneic and Autologous Transplantation: Late Complications and Approaches to Disease Recurrence: Poster I
See more of: Clinical Allogeneic and Autologous Transplantation: Late Complications and Approaches to Disease Recurrence
See more of: Oral and Poster Abstracts

Previous Abstract | Next Abstract >>

^*signifies non-member of ASH

1956 Extensive Chronic Graft-Versus-Host-Disease Significantly Increases the Risk of Severe and Multifocal Genital Tract HPV Disease in Long-Term Survivors of Allogeneic Stem Cell Transplantation