Transplant Cell Ther. 2021 Aug 30:S2666-6367(21)01169-6. doi: 10.1016/j.jtct.2021.08.020. Online ahead of print.
ABSTRACT
INTRODUCTION: Each year more than 8,000 allogeneic stem cell transplantations (allo-SCT) are performed in the United States and approximately 30% of these patients are ≥60 years old. Allo-SCT cases have increased risk to develop human papillomavirus (HPV)-related precancer or second malignancy. It is important to evaluate HPV-related precancer or second malignancy among allo-SCT cases to develop or enhance screening and preventive practice guidelines to improve patients’ survival and quality of life.
OBJECTIVE: We estimated the cumulative incidence of HPV-related precancer or second malignancy in both male and female Medicare beneficiaries who received allo-SCT and compared it with non-SCT controls and non-cancer controls.
MATERIALS AND METHODS: This is a retrospective matched case control study. Hematologic cancer patients aged ≥18 years who received allo-SCT between 2002 and 2011 were matched 1:5 to non-SCT controls and to non-cancer controls by age, sex, race/ethnicity, and follow-up time. Proportions of HPV-related precancer or second malignancy were estimated and compared between cases and controls using Chi-square test and logistic regression. Kaplan-Meier cumulative incidences were estimated and compared using log rank tests.
RESULTS: We identified 700 allo-SCT cases (median age of 64 years and median follow-up time post-transplant of 4.3 years) matched with 3159 non-SCT controls and 3302 non-cancer controls. About 3.7% of allo-SCT cases developed HPV-related precancer or second malignancy post-transplant, compared with 1.9% in the non-SCT controls and 1.1% in the non-cancer controls. The odds ratio of developing HPV-related precancer or second malignancy of allo-SCT cases compared with non-SCT controls and non-cancer controls was 2.0 (95% confidence interval [CI]: 1.25-3.18) and 3.5 (95% CI: 2.1-5.8), respectively. Both allo-SCT cases and non-SCT controls had significantly higher proportions and odds in developing HPV-related precancer or second malignancy than non-cancer controls. The 5-year cumulative incidence in allo-SCT cases was 5% compared with 2.1% in non-SCT controls and 1.2% in non-cancer controls. The cumulative incidence of HPV-related precancer or second malignancy in the allo-SCT was statistically significantly higher than either of the two matched control groups, and non-SCT controls had a higher cumulative incidence of HPV-related precancer or second malignancy than that in non-cancer controls.
DISCUSSION: Allo-SCT cases were at increased risk of developing HPV-related precancer or second malignancy compared with non-SCT controls and non-cancer controls. Routine screening of HPV-related precancer or second malignancy in allo-SCT cases is needed to prevent HPV-related precancer or second malignancy.
PMID:34474166 | DOI:10.1016/j.jtct.2021.08.020
