Introduction: Bone marrow transplantation is a procedure frequently used in high-risk hematological diseases. It is of great importance to determine the follow-up protocols to be applied after the procedure. Follow-up after bone marrow transplantation in women includes general gynecological examination and smear examinations. There are studies in the literature showing that smear abnormalities increase in these patients and false positive cytology may be reported as a result of changes in the cervical epithelium. In our study, we aimed to evaluate smear abnormalities in patients who underwent bone marrow transplantation and to compare smear results with colposcopy results.
Method: 490 patients who underwent bone marrow transplantation between 2012 and 2023 were included in the study. The patients' smear test results were evaluated. The age, gravida, body mass index, diagnosis, HPV test results, colposcopy results, and surgical interventions, if any of the patients with abnormal smear results were recorded.
Results: The median age of the patients was 43 (30-68), median gravida was 2 (0-5) and median body mass index was 23.4 (18.3-42.4). Abnormal cervical cytology was detected in 19 (3.9%) of the patients. HPV results were obtained for a total of 9 patients. 6 of them were negative.While the smear result of the patient with HPV 68 was HGSIL, the smear result of the other HPV positive cases was ASCUS. The cytology of 5 of the 6 HPV negative patients was ASCUS, and the result of 1 was ASC-H. When we compared the smear and colposcopy results, 1 of the 2 patients with HGSIL had a colposcopy result of LGSIL, the other had HGSIL, and 1 of the 2 patients with ASC-H cytology did not accept the colposcopy procedure, and the other's colposcopy was normal. Colposcopy of 1 patient with LGSIL cytology was normal. Colposcopy was not performed in 7 of the 11 patients with ASC-US cytology, and the colposcopy of 4 was normal. Colposcopy of 2 patients with AGC cytology was normal.
Conclusion: In cases of bone marrow transplantation, regular gynecological examination and smear checks are vital to enable early diagnosis and treatment of cervical cancer. In addition, it should not be forgotten that HPV will be activated in immunosuppression in these cases, and the patient should be diagnosed and treated at an early stage by using colposcopy in case of cervical smear abnormalities.