Abnormal cervical cytology after allogeneic bone marrow transplantation

• Published in: American journal of clinical pathology Vol. 142; no. 2; pp. 222 - 226
• Main Authors: Negri, Giovanni, Herz, Martina, Deola, Sara, Piccin, Andrea, Casini, Marco, Babich, Bianca, Tauber, Martina, Messini, Sergio, Marucci, Maria Raffaella, Vittadello, Fabio
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.08.2014
• Subjects: Adult; Aged; Bone Marrow Transplantation - methods; Female; Humans; Middle Aged; Neoplasm Grading; Papanicolaou Test - methods; Pregnancy; Transplantation, Homologous - methods; Treatment Outcome; Uterine Cervical Dysplasia - pathology; Uterine Cervical Dysplasia - therapy; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - therapy; Vaginal Smears - methods; Young Adult; Cervical cytology; Bone marrow transplantation; Pap smear; Busulfan; Atypia
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1309/ajcp4skaus9totjx

Allogeneic bone marrow transplantation (BMT) is a procedure mostly used for high-risk hematologic malignances. In women, follow-up protocols after BMT include gynecologic checkups with Papanicolaou (Pap) smears. We evaluated 117 Pap smears in 54 women who underwent allogeneic BMT and correlated the smear morphology with the BMT-related medical treatment. Abnormal Pap smears after BMT were found in 13 (24.1%) women. Four (7.4%) women had at least one smear with atypical squamous cells of unknown significance, six (11.1%) had a low-grade squamous intraepithelial lesion, and three (5.6%) had atypical squamous cells/high-grade lesion cannot be excluded (ASC-H). The three patients with ASC-H showed high-grade atypia mimicking cancer but had a negative follow-up. Nine women, including the three with ASC-H, had undergone a conditioning therapy for BMT that included busulfan. No association between other drugs and therapy-related atypia was found. Pap smears after BMT show a high incidence of dysplastic lesions. Moreover, conditioning including busulfan is often associated with therapy-related cytologic atypia, which may lead to unnecessary colposcopies and biopsies. Knowledge of the patient's history and a careful evaluation of the smears are mandatory in these cases.