Human papillomavirus-related squamous cell carcinomas after blood or marrow transplantation-a Blood or Marrow...

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

We determined the risk of HPV-related squamous cell carcinomas in 7936 2-year survivors of autologous or allogeneic blood or marrow transplantation performed between 1974 and 2014 and identified the role of demographic and clinical factors associated with HPV-related squamous cell carcinomas using proportional subdistribution hazards model for competing risks. Standardized incidence ratio was used to compare the risk of HPV-related squamous cell carcinoma with age-, sex-, and calendar-specific incidence in the general population.

The median age at transplantation was 46 years (range = 0-78 years); 58.5% (n = 4642) were male, and 72.2% (n = 5727) were non-Hispanic White. Half (50.3%, n = 3991) of the patients had received an allogeneic blood or marrow transplantation. The standardized incidence ratio for oropharyngeal squamous cell carcinomas (n = 53) was 1.8 (95% confidence interval [CI] = 1.3 to 2.3) and for cervical squamous cell carcinoma among female blood or marrow transplantation recipients (n = 26) was 9.4 (95% CI = 6.3 to 13.6) compared with the general US population. The hazard of an HPV-related squamous cell carcinoma was higher among allogeneic blood or marrow transplantation recipients with chronic graft vs host disease (any HPV-related squamous cell carcinoma: HR = 6.24, 95% CI = 3.11 to 12.50; oropharyngeal: HR = 4.85, 95% CI = 2.11 to 11.15; cervical: HR = 4.98, 95% CI = 1.65 to 15.00; reference: autologous blood or marrow transplantation). Pre-blood or marrow transplantation radiation increased the risk of oropharyngeal squamous cell carcinoma (HR = 2.98, 95% CI = 1.57 to 5.65).

These findings underscore the importance of risk-based HPV vaccination and surveillance after blood or marrow transplantation.