Abnormal cervical cytology in bone marrow transplant recipients

Particular human papillomavirus (HPV) subtypes are implicated in the genesi s of abnormal cervical cytology and cervical cancer. While most immunocompe tent hosts clear HPV infection with no sequelae, some develop premalignant cytological changes of whom a minority subsequently progress to overt carci noma. Immunocompromised patients, such as renal allograft recipients and HI V-infected individuals, have a higher rate of cytological abnormalities. Th is is thought to be due to prolonged persistence of virus due to impaired c learance by the immune system. We undertook a retrospective review of the c ervical cytology of all women who underwent BMT at two transplant centres a nd who had cervical smears performed between 1990 and 1998. The rate of cyt ological abnormalities was significantly higher than in the general populat ion before BMT (age-adjusted odds ratio (OR) 2.2, P = 0.02) and after BMT ( OR 7.0, P < 0.0001). After BMT, allogeneic recipients had a higher rate of abnormalities than did autologous patients (OR 2.6, P = 0.02) although only allogeneic recipients had a higher rate of abnormalities post-BMT compared to pre-BMT (allogeneic OR 6.8, P = 0.004). These observations suggest that pre-transplant disease and treatment factors increase the risk of cytologi c abnormalities and that transplant-related factors such as conditioning th erapy and immunosuppression further increase this risk. These data suggest that more frequent screening may be required in these at-risk groups, espec ially allogeneic recipients. Prospective studies are required to further ev aluate cytological abnormalities and HPV shedding in these populations.