ABSTRACT
This longitudinal single-center study describes the timing and risk factors for genital human papillomavirus (HPV) disease in women after allogeneic hematopoietic cell transplantation (HCT). Between 1994 and 2014, 109 females underwent HCT of whom 82 surviving transplant for >1 year had regular, comprehensive genital tract assessment and treatment of HPV disease. The cumulative proportions of any genital HPV infection at 1, 3, 5, 10 and 20 years were 4.8%, 14.9%, 28.1%, 36.7% and 40.9%, respectively. Demographic, disease-related factors, chronic GvHD (cGvHD) and its treatment were analyzed for their association with persistent, multifocal or severe genital HPV disease. Pre-transplant HPV disease was strongly associated with any posttransplant HPV (odds ratio (OR)=6.5, 95% confidence interval (CI)=1.65-25.85, P=0.008). Having either extensive or genital cGvHD was associated with increased risk of any HPV disease (OR=5.7, 95% CI=1.90-17.16, P=0.002) and a higher risk for severe genital dysplasia (CIN II-III/VIN II-III; OR=13.1, 95% CI=1.59-108.26, P=0.017), but no one developed HPV-related genital cancer. Persistent, multifocal or severe HPV disease occurred more frequently than in healthy populations. Women with extensive cGvHD, genital cGvHD or pre-transplant HPV are at greatest risk for post-transplant HPV disease. Early initiation of annual screening, comprehensive genital tract assessment and active management are cornerstones of their gynecology care.
Subject(s)
Papillomaviridae/pathogenicity , Papillomavirus Infections/etiology , Stem Cell Transplantation/adverse effects , Adolescent , Adult , Female , Humans , Longitudinal Studies , Mass Screening , Middle Aged , Papillomavirus Infections/pathology , Risk Factors , Young AdultSubject(s)
Angiopoietin-2/blood , Biomarkers, Tumor/blood , Hepatic Veno-Occlusive Disease/blood , Hodgkin Disease , Interleukin-1 Receptor-Like 1 Protein/blood , Leukemia, Myeloid, Acute , Neoplasm Proteins/blood , Stem Cell Transplantation , Adult , Allografts , Female , Hepatic Veno-Occlusive Disease/etiology , Hodgkin Disease/blood , Hodgkin Disease/therapy , Humans , Leukemia, Myeloid, Acute/blood , Leukemia, Myeloid, Acute/therapy , MaleSubject(s)
Biomarkers/blood , Graft vs Host Disease/blood , Graft vs Host Disease/diagnosis , Adolescent , Adult , Aged , Child , Enzyme-Linked Immunosorbent Assay , Female , Hematologic Neoplasms/therapy , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Leukemia, Myeloid, Acute/therapy , Lymphoma, Non-Hodgkin/therapy , Male , Microfluidic Analytical Techniques , Middle Aged , Myelodysplastic Syndromes/therapy , Reproducibility of Results , Retrospective Studies , Young AdultABSTRACT
Accelerated bone mineral density loss (BMDL) occurs early after allogeneic stem cell transplantation (SCT) and is related to factors such as steroids and chronic GvHD. In order to understand the natural history of BMDL of SCT in the longer term, we evaluated a longitudinal cohort of 148 survivors with a median follow-up of 12 years (range 3-22 years). All women received hormone replacement therapy, and routine calcium/vitamin D supplementation was recommended but â¼50% of patients still had suboptimal vitamin D levels and bisphosphonates were rarely utilized. BMD significantly improved from 5 to 20+ years but the femoral neck and forearm remained vulnerable sites. Younger age, higher pretransplant body mass index (BMI) and increment in BMI post transplant were significantly associated with increased BMD and protected against osteopenia/osteoporosis. These findings support consideration of BMD loss in SCT survivors in two phases, an early phase of BMD loss (3-5 years) followed by a later phase of BMD recovery, with different protective and aggravating factors. Treatment- and transplant-related factors (such as steroids, immunosuppressives, chronic GvHD, vitamin D) are known to impact the early phase of BMD loss but age and BMI are more influential in the late phase of BMD recovery.
Subject(s)
Bone Density/drug effects , Osteoporosis/chemically induced , Stem Cell Transplantation/adverse effects , Survivors , Adolescent , Adult , Aged , Child , Diphosphonates/therapeutic use , Female , Femur Neck/pathology , Forearm/pathology , Hormone Replacement Therapy , Humans , Longitudinal Studies , Male , Middle Aged , Osteoporosis/drug therapy , Osteoporosis/prevention & control , Retrospective Studies , Time Factors , Transplantation, Homologous , Vitamin D/therapeutic use , Young AdultSubject(s)
Comorbidity , Hematopoietic Stem Cell Transplantation , Lymphocyte Depletion , T-Lymphocytes , Adolescent , Adult , Allografts , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Retrospective StudiesABSTRACT
Neurocysticercosis, an infection of the central nervous system with the larval stage of the cestode Taenia solium, is common in developing countries but its occurrence and management in allogeneic hematopoietic stem cell transplantation (HSCT) has not been reported previously, to our knowledge. We report the case of an immigrant female patient who underwent a matched-related allogeneic HSCT for acute lymphoblastic leukemia and was incidentally found to have a solitary viable neurocysticercosis lesion. However, despite severe immunosuppression, the size of the cyst did not increase. More importantly, restoration of the immune system did not induce significant inflammation or seizures. Subsequent follow-up demonstrated complete resolution of the neurocysticercosis lesion. Thus, in the setting of HSCT, an asymptomatic patient with a single neurocysticercosis lesion was successfully managed without the use of anthelmintics, steroids, or anti-epileptics.
