Hematopoietic Cell Transplantation and Outcomes Related to Human Papillomavirus Disease in GATA2 Deficiency
Por:
Parta M., Cole K., Avila D., Duncan L., Baird K., Schuver B.B., Wilder J., Palmer C., Daub J., Hsu A.P., Zerbe C.S., Marciano B.E., Cuellar-Rodriguez J.M., Bauer T.R., Nason M., Calvo K.R., Merideth M., Stratton P., DeCherney A., Shah N.N., Holland S.M., Hickstein D.D.
Publicada:
1 ene 2021
Resumen:
GATA2 deficiency is a bone marrow failure syndrome effectively treated with hematopoietic cell transplantation (HCT), which also addresses the predisposition to many infections (prominently mycobacterial). However, many GATA2-deficient persons who come to HCT also have prevalent and refractory human papilloma virus disease (HPVD), which can be a precursor to cancer. We analyzed 75 HCT recipients for the presence of HPVD to identify patient characteristics and transplantation results that influence HPVD outcomes. We assessed the impact of cellular recovery and iatrogenic post-transplantation immunosuppression, as per protocol (PP) or intensified/prolonged (IP) graft-versus-host disease (GVHD) prophylaxis or treatment, on the persistence or resolution of HPVD. Our experience with 75 HCT recipients showed a prevalence of 49% with anogenital HPVD, which was either a contributing or primary factor in the decision to proceed to HCT. Of 24 recipients with sufficient follow-up, 13 had resolution of HPVD, including 8 with IP and 5 with PP. Eleven recipients had persistent HPVD, including 5 with IP and 6 with PP immunosuppression. No plausible cellular recovery group (natural killer cells or T cells) showed a significant difference in HPV outcomes. One recipient died of metastatic squamous cell carcinoma, presumably of anogenital origin, at 33 months post-transplantation after prolonged immunosuppression for chronic GVHD. Individual cases demonstrate the need for continued aggressive monitoring, especially in the context of disease prevalent at transplantation or prior malignancy. HCT proved curative in many cases in which HPVD was refractory and recurrent prior to transplantation, supporting a recommendation that HPVD should be considered an indication rather than contraindication to HCT, but post-transplantation monitoring should be prolonged with a high level of vigilance for new or recurrent HPVD. © 2021 The American Society for Transplantation and Cellular Therapy
Filiaciones:
Parta M.:
Clinical Research Directorate, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
Cole K.:
Nursing Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
Avila D.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Duncan L.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Baird K.:
Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Schuver B.B.:
Office of the Clinical Director, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Wilder J.:
Clinical Research Directorate, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
Palmer C.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Daub J.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Hsu A.P.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Zerbe C.S.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Marciano B.E.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Cuellar-Rodriguez J.M.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Bauer T.R.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Nason M.:
Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
Calvo K.R.:
Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
Merideth M.:
National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
Stratton P.:
Office of the Clinical Director, National Institute of Neurological Disease and Stroke, National Institutes of Health, Bethesda, MD, United States
DeCherney A.:
National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, United States
Shah N.N.:
Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Holland S.M.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Hickstein D.D.:
Immune Deficiency–Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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