Oral squamous cell carcinoma positive for p16/human papilloma virus in post allogeneic stem cell transplantation: 2 cases and review of the literature

Abstract

Complications of allogeneic hematopoietic stem cell transplantation (allo-HSCT) includes the risk of secondary malignancies. This may be related to mechanisms including radiation and chemotherapy regimens, chronic graft-versus-host disease, inflammation, and prolonged imunosuppression. Oral squamous cell carcinoma (OSCC) is a complication associated with chronic graft-versus-host disease after allo-HSCT. Although human papillomavirus (HPV) is known to be associated with OSCC, the role of HPV in development of OSCC in post-HSCT patients has not been studied. We identified 2 cases of OSCC in allo-HSCT recipients. Both biopsy specimens tested positive for p16(INK4A), a surrogate marker for HPV. We propose that the association of OSCC and HPV in patients after allo-HSCT may not be incidental. Clinical implications of these cases may imply the need for a HPV screening, early intervention, and consideration of anti-HPV vaccination in this population. The effectiveness of such interventions could be validated in a prospective clinical study.

HPV‐related oral dysplasia in a multiple myeloma patient after stem cell transplantation

“…HPV was documented in a biopsy of oral verruca vulgaris in a patient undergoing myeloablative HSCT . In Addition, it was detected in two OSCC cases who are post allogenic HSCT . High‐risk HPV was found to be associated with a subset of oral epithelial dysplasia, and the dyskeratotic cells were seen throughout the thickness of the epithelium .…”

Malignant Transformation of Fanconi Anemia Complementation Group D2-deficient (Fancd2−/−) Hematopoietic Progenitor Cells by a Single HPV16 Oncogene

“…These data demonstrate an alarming age-dependent increase in frequency of appearance of these cancer types, the etiology of which remain unknown. Despite the search for HPV as a potential cofactor in oncogenic transformation (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33), and for other bacterial and viral pathogens, no etiological agent has yet been identified.…”

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Immune Dysregulation and Pathobiology Working Group Report

“…Improved screening of blood and transplant donors, use of the hepatitis B vaccine, and the use of hepatitis B antivirals and the recent introduction of potent hepatitis C antivirals have resulted in a lessening of the risk for late hepatitis complications. Recent recognition of HPV-associated gynecologic and head and neck carcinomas has led to calls for consideration of the HPV vaccine for prevention 30–32 . It is possible that other late viral associated complications will be identified with the increasing number of recipients surviving beyond 10 years and the identification of new viral pathogens and their associations with transplant complications.…”