Department of Gynecology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Biol Blood Marrow Transplant. 2012 May;18(5):747-53. doi: 10.1016/j.bbmt.2011.09.012. Epub 2011 Oct 1.
This retrospective study examined the prevalence of and risk factors for cervical dysplasia and genital human papillomavirus (HPV) infection in 89 female recipients of allogeneic stem cell transplantation (allo-SCT) between 1985 and 2005 who survived for more than 5 years after transplantation. All patients underwent regular gynecologic examination and cervical cytological testing. The incidence rates of cervical cytological abnormalities and HPV infection were calculated. Various clinical parameters were evaluated for association with cytological high-grade squamous intraepithelial lesion (HSIL) posttransplantation to identify risk factors for cervical dysplasia. Multivariate analysis with logistic regression was used to identify independent risk factors for cervical dysplasia after adjusting for confounding factors. Sixty-one of the 89 patients (68.5%) had cervical cytological abnormalities of varying grades, including atypical squamous cells of undetermined significance (ASC-US; 31.5%; 28 of 89), low-grade squamous intraepithelial lesion (LSIL; 10.1%; 9 of 89), and HSIL (27%; 24 of 89). HPV status was available for 43 patients, 12 of whom (27.9%) were HPV-positive. Among the 69 patients with normal cytological cervical smear findings pretransplantation, the incidence of cytological HSIL was 23.2% (16 of 69) posttransplantation. After adjusting for confounding factors, only unrelated HLA-matched donor and the presence of vulvovaginal chronic graft-versus-host disease (cGVHD) were independent risk factors for cervical cytology HSIL after transplantation, with the highest risk among patients with vulvovaginal cGVHD (adjusted odds ratio, 31.97). We conclude that long-term survivors of allogeneic stem cell transplantation are at high risk for cervical cytological abnormalities. Vulvovaginal cGVHD and unrelated HLA-matched donor were the only independent risk factors for cervical cytological HSIL in patients with normal cervical cytology before transplantation. Regular surveillance by gynecologic examination, including cervical cytological testing, in these patients allows for early diagnosis and effective management of cervical abnormality and decreases the burden of this potentially fatal, but treatable, condition.
本回顾性研究调查了 1985 年至 2005 年间接受同种异体干细胞移植（allo-SCT）且移植后存活超过 5 年的 89 名女性患者的宫颈发育不良和生殖器人乳头瘤病毒（HPV）感染的流行率和危险因素。所有患者均接受定期妇科检查和宫颈细胞学检查。计算宫颈细胞学异常和 HPV 感染的发生率。评估各种临床参数与移植后宫颈高级别鳞状上皮内病变（HSIL）的关系，以确定宫颈发育不良的危险因素。采用多变量逻辑回归分析调整混杂因素后，识别宫颈发育不良的独立危险因素。89 例患者中有 61 例（68.5%）出现不同程度的宫颈细胞学异常，包括非典型鳞状细胞意义不明（ASC-US；31.5%；89 例中有 28 例）、低度鳞状上皮内病变（LSIL；10.1%；89 例中有 9 例）和 HSIL（27%；89 例中有 24 例）。43 例患者的 HPV 状态可查，其中 12 例（27.9%）HPV 阳性。在移植前宫颈细胞学涂片正常的 69 例患者中，移植后细胞学 HSIL 的发生率为 23.2%（69 例中有 16 例）。调整混杂因素后，仅无关 HLA 匹配供体和存在外阴阴道慢性移植物抗宿主病（cGVHD）是移植后宫颈细胞学 HSIL 的独立危险因素，其中外阴阴道 cGVHD 患者风险最高（调整优势比，31.97）。我们得出结论，接受同种异体干细胞移植的长期幸存者患宫颈细胞学异常的风险很高。外阴阴道 cGVHD 和无关 HLA 匹配供体是移植前宫颈细胞学正常患者发生宫颈细胞学 HSIL 的唯一独立危险因素。对这些患者进行妇科检查，包括宫颈细胞学检查的定期监测，可早期诊断和有效管理宫颈异常，降低这种具有潜在致命性但可治疗的疾病的负担。
