Human papillomavirus-related squamous cell carcinomas after blood or marrow transplantation-a BMTSS report.

Abstract

Background: Human papillomavirus (HPV) is associated with an increased risk for a variety of squamous cell carcinomas (SCCs) in the general population. The risk for subsequent SCCs in BMT survivors that are potentially related to HPV (cervical, oropharyngeal, vulvar, vaginal, anal, and penile cancer; HPV-related SCCs) remains unknown.

Methods: We determined the risk of HPV-related SCCs in 7,936 2 y-survivors of autologous or allogeneic BMT performed between 1974 and 2014 and identified the role of demographic and clinical factors associated with HPV-related SCCs using proportional subdistribution hazards model for competing risks. Standardized incidence ratio (SIR) was used to compare the risk of HPV-related SCC with age-, sex-, and calendar-specific incidence in the general population.

Results: The median age at transplantation was 46 y (range, 0-78 y); 58.5% (n = 4,642) were males, and 72.2% (n = 5,727) were non-Hispanic White. Half of the patients (50.3%, n = 3,991) had received an allogeneic BMT. The SIR for oropharyngeal SCC (n = 53) was 1.8 (95%CI = 1.3-2.3) and for cervical SCC among female BMT recipients (n = 26) was 9.4 (95%CI = 6.3-13.6), compared to the general US population. The hazard of an HPV-related SCC was higher among allogeneic BMT recipients with chronic graft vs host disease (cGvHD) (any HPV-related SCC: HR = 6.24, 95%CI = 3.11-12.50; oropharyngeal: HR = 4.85, 95%CI = 2.11-11.15; cervical: HR = 4.98, 95%CI = 1.65-15.00; reference=autologous BMT). Pre-BMT radiation increased the risk of oropharyngeal SCC (HR = 2.98, 95%CI = 1.57-5.65).

Conclusion: These findings underscore the importance of risk-based HPV vaccination and surveillance after BMT.