Considerations on management of advanced cervical squamous cell carcinoma in a solid organ transplant and...

Immunocompromised patients, such as those with systemic lupus erythematosus (SLE) and solid organ transplantation (SOT) are at increased risk for persistent high-risk human papilloma viral (HPV) infection and cervical cancer due to chronic immunosuppression.

A 35-year-old woman with SLE and a right pelvic renal transplant was diagnosed with HPV16-positive cervical squamous cell carcinoma. Despite history of abnormal Pap smear, inconsistent screening led to a delayed diagnosis. She underwent surgical management first followed by chemoradiation. Surgical pathology confirmed FIGO Stage IIIC1 disease. With disease progression to pulmonary, hepatic and osseous sites, the patient was started on platinum-based chemotherapy with immune checkpoint inhibitors leading to acute kidney transplant rejection. She was transitioned to dialysis and continues palliative chemotherapy.

This case highlights the challenges of treating cervical cancer in an immunosuppressed renal-transplant recipient and emphasizes the importance of individualized screening and multidisciplinary care. Immunotherapy use in transplant patients warrants cautious consideration with thorough risk-benefit counseling.