5. Human Papillomavirus Vaccination Uptake in Adolescent Survivors of Bone Marrow Transplant

Background Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and can lead to cervical, oropharyngeal, and anogenital dysplasia and malignancy. Vaccination against HPV is recommended for all adolescents but is particularly important in patients with a history of bone marrow transplant (BMT) as they can have higher rates of persistent HPV-related disease or secondary cancers. Because of lost or reduced immunity after BMT, patients who previously received the vaccine must be re-vaccinated after transplant. The purpose of the current study is to characterize the rate and clinical factors associated with HPV vaccine uptake in the adolescent BMT population. Methods This IRB-approved retrospective study evaluated the vaccine history of a cohort of adolescent BMT survivors transplanted between 2015 and 2022 at a tertiary care medical center. Subjects were included if they were ≥ 11 years old, ≥ 12 months status post BMT, and medically eligible to receive the HPV vaccine. Logistic regression was used to examine the bivariate associations between HPV vaccine uptake after BMT and the following covariates: age, sex, geographic region of origin, race, primary language, insurance status, indication for and type of BMT, receipt of other age-based vaccines, and receipt of COVID and flu vaccines. Results Among 119 (n=53 female; n=66 male) study-eligible BMT survivors, 66 (55.5%) received at least one dose of the HPV vaccine after BMT. Among those who initiated vaccination, 45/66 (68.2%) completed two or more doses, with an initial dose at a median of 2.1 years (IQR 1.4, 3.4) after BMT. Of 69 patients who were eligible to receive the vaccine prior to BMT, 19/36 (52%) were vaccinated both before and after BMT, compared to 14/33 (42%) who did not receive the vaccine before BMT but chose to be vaccinated after BMT. No statistically significant difference was identified between those who did and did not initiate HPV vaccination after BMT among covariates examined in this study. Conclusions The overall rate of HPV vaccine uptake after BMT in this study (55%) was lower than the national average (76%) but higher than previously reported studies in childhood cancer survivors (24-48%). Patients who received HPV vaccination prior to BMT chose to re-vaccinate after BMT at higher rates than patients who did not receive the HPV vaccine prior to BMT. Additional research is needed to characterize barriers to HPV vaccine uptake in this population.