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Tanweer MS, Aljurf M, Savani BN, Iqbal PK, Hashmi S. Lower Genital Tract Precancer and Cancer in Hematopoietic Cell Transplant Survivors and the Role of HPV: A Systematic Review and Future Perspectives. Clin Hematol Int 2019; 1:142-153. [PMID: 34595424 PMCID: PMC8432365 DOI: 10.2991/chi.d.190519.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/14/2019] [Indexed: 12/04/2022] Open
Abstract
Female recipients of hematopoietic cell transplant (HCT) may develop lower genital tract (LGT) dysplasia or new malignancies. A comprehensive systematic review to delineate the occurrence and risk factors for post-HCT LGT precancer and cancer in women was conducted via electronic search of the Cochrane Library, PubMed, Embase, Wiley Online Library, from 1990 to 2018. All studies on the risk, presentation, or incidence of LGT (cervix, vulva, vagina) precancer or cancer post-HCT were included. Reviews, case reports, meta-analysis, book chapters, and studies without the relevant clinical outcomes were excluded. Post-HCT incidence and risk factors for developing LGT precancer or cancer were assessed and determined. Twenty-two out of the original 344 studies met the selection criteria. The risk of LGT cancers in allo-HCT recipients was found to be significantly higher than in the general population, with the standardized incidence ratios of 1.5–48 for cervical cancer and from 19 to 287 for dysplasia. Our review portrays an increased risk of premalignant and malignant neoplasms of female LGT, which have an incompletely described epidemiology and outcomes. Similar to other immunocompromised states, HCT recipients require specific cervical screening guidelines and can greatly benefit from HPV vaccinations. However, there is a lack of prospective data regarding optimum cervical screening in HCT recipients and limited programs offer HPV vaccinations worldwide.
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Affiliation(s)
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center Search, Riyadh, Kingdom of Saudi Arabia
| | - Bipin N Savani
- Department of Medicine, Vanderbilt University Medical Center Search, TN, USA
| | - Perviz K Iqbal
- Department of Medicine, King Faisal Specialist Hospital and Research Center Search, Riyadh, KSA
| | - Shahrukh Hashmi
- Oncology Center, King Faisal Specialist Hospital and Research Center Search, Riyadh, Kingdom of Saudi Arabia
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Saco A, Alòs S, Esteve R, Suárez-Lledó M, Martínez C, Perez FM, Vega N, Martí C, Torne A, Ordi J, Del Pino M. Atypical cytological changes mimicking SIL of the uterine cervix in allogenic hematopoietic stem cell transplantation recipients treated with busulfan. Cancer Cytopathol 2019; 127:399-406. [PMID: 31145550 DOI: 10.1002/cncy.22148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Allogenic hematopoietic stem cell transplantation (allo-HSCT) is a common procedure in hematological disorders and is preceded by a conditioning regimen that usually includes busulfan. The immunosuppression caused by the conditioning regimen and graft-versus-host disease prophylaxis is associated with human papillomavirus (HPV) persistence and, consequently, with an increased risk of cervical cancer (CC) and squamous intraepithelial lesions (SILs)-the precursors of CC. A gynecological check-up that includes CC screening is recommended in these patients. METHODS All female recipients of allo-HSCT undergo routine gynecological check-up that includes CC screening. Cervical samples were obtained for liquid-based cytology and HPV testing. Cytology smears were stained with the Papanicolaou (Pap) technique. A colposcopy evaluation was performed if any abnormal result in the screening tests was obtained. RESULTS Among 15 women undergoing gynecological examination at 1 year after allo-HSCT who had received a conditioning regimen that included busulfan, 4 (26.7%) showed atypical squamous cells in the Pap smear, suggesting high-grade SIL. The abnormalities were identified from 136 to 271 days after allo-HSCT. In all cases, HPV testing was negative, and colposcopy examination was normal. The cytological abnormalities regressed in 3 of the women after 1 year but persisted in 1 woman at day 382 after allo-HSCT. CONCLUSIONS Treatment-related atypia mimicking SIL is a common finding in allo-HSCT recipients who have received busulfan, particularly in the first year after the procedure. However, atypical changes may persist for more than 1 year. Clinical information, HPV testing, and colposcopy examination are critical to prevent misdiagnosis and overtreatment in these patients.
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Affiliation(s)
- Adela Saco
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Silvia Alòs
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Roser Esteve
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Long-Term Follow-Up Unit and Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Long-Term Follow-Up Unit and Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain
| | - Francisco M Perez
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Naiara Vega
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Cristina Martí
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain
| | - Aureli Torne
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain
| | - Jaume Ordi
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain.,ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Marta Del Pino
- Long-Term Follow-Up Unit and Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain.,Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, August Pi i Sunyer Institute for Biomedical Investigations, University of Barcelona, Barcelona, Spain
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