Immunogenicity of HPV Quadrivalent Vaccine in Women after Allogeneic HCT is Comparable to Healthy Volunteers

Abstract

We studied the outcome significance of pre-HCT colonization with intrinsics by reviewing the medical records of all allo-HCT recipients with available pre-HCT rectal swab or stool culture results at our institution (2011)(2012)(2013)(2014)(2015)(2016)(2017). Cases with ≥1 positive pre-HCT result for E. gallinarum or E. casseliflavus and no positive test for VRE were defined as intrinsics. Patients with no positive pre-HCT test for intrinsics or VRE, and with at least 2 negative tests for these, were defined as controls. Due to the rare occurrence of colonization with intrinsics and the preponderance of pediatric patients with this condition, each intrinsic was matched to a control using the following hierarchical criteria: (i) Disease (malignant vs. nonmalignant), (ii) disease risk (standard vs. high vs. nonmalignant), (iii) donor (sibling vs. unrelated vs. cord), (iv) conditioning (ablative vs. reduced-intensity), and (v) age (±10 years). The groups were similar in all studied variables (Table 1). The intrinsic group had a higher 2-year overall survival (OS) of 86 [52-96]% vs. controls with OS of 35 [8-65]% (P < .01, Figure 1). This remarkable difference was due to a significantly lower non-relapse mortality (NRM) in the intrinsic group (0% vs. 36 [8-65]%, P = .01). Both deaths in the intrinsic group were due to relapse. In contrast, deaths in the control group were due to organ failure in 45%, relapse in 33%, infection in 11%, and GVHD in 11%. Other transplant outcomes (GVHD and relapse) were similar between the groups.

A Practical Guide to Gynecologic and Reproductive Health in Women Undergoing Hematopoietic Stem Cell Transplant

“…As with other vaccinations post-HCT, the full regimen for vaccination is recommended and includes 3 doses at 0, 2, and 6 months [82]. Preliminary evidence indicates that the immunologic response to vaccination is robust and similar to that of immunocompetent women, but whether it decreases the risk of HPV disease warrants further study [83]. Because HPV incidence is high and HPV disease generally occurs later after HCT, combining vaccinating reproductive-aged women up to age 45 or 50 with periodic cervical cytology/HPV screening may be an effective strategy to reduce HPV-associated intraepithelial neoplasia and malignant disease in this population [82,84,85].…”

Lower Genital Tract Precancer and Cancer in Hematopoietic Cell Transplant Survivors and the Role of HPV: A Systematic Review and Future Perspectives

“…Nonetheless, these studies do not attribute any adverse effects to the HPV vaccine, nor do they alter the course of the original disease, demonstrating its safety [ 53 , 64 , 65 ]. Results from a recent large study on women posttransplant on low dose IST or not on any IST showed that they can mount a response to HPV vaccine and, thus, vaccination will likely become a recommended strategy in the future [ 66 ].…”