(0695) Outcomes Among Patients With Co-Diagnoses of Oropharyngeal Cancer and Malignant Lymphoproliferative Disorders

Introduction: Human Papillomavirus (HPV) causes most oropharynx squamous cell carcinomas (OPCs) in the US. Immune suppression is associated with both HPV infection and lymphoproliferative disorders (LPD), but little is known about the interaction between HPV-positive OPC and LPD. This study aimed to describe characteristics and outcomes of patients diagnosed with both LPD and OPC.

Methods: Patients evaluated at Dana-Farber Cancer Institute between 2001 and 2020 for OPC or LPD, who also had a diagnosis of LPD or OPC, respectively, were included. Demographic and clinical characteristics were compared with two-sided Fishers exact tests. Overall survival (OS) was calculated from date of OPC diagnosis using the Kaplan-Meier method, and compared by HPV status using Cox Proportional Hazards.

Results: Out of 53 patients identified, 38% were diagnosed with OPC first, and 62% with LPD first. 57% of OPCs were HPV+. Median ages at OPC and LPD diagnosis were 62 and 61, respectively. Patients diagnosed with LPD first were more likely to have surgery (51% vs 30%) and less likely to have radiation (66% vs 100%) than patients with OPC first (p = 0.03), although tumor and nodal stages were similar.

Median follow-up was 59 months. Patients with HPV-negative OPC had shorter OS than patients with HPV-positive OPC (HR 5.6, 95% CI 2.2-14.3; p < 0.001). 2- and 5-year OS for HPV-positive OPC patients was 85% (95%CI=65-93%) and 58% (95%CI = 37-75%), respectively.

HPV-positive OPC patients with previous LPD diagnosis tended to have shorter OS after OPC diagnosis than those diagnosed with LPD after OPC (HR = 1.9, 95%CI = 0.6-5.4).

Conclusions: Previous diagnosis of LPD was associated with different treatment approaches for OPC patients. HPV-positive tumor status was associated with favorable prognosis after OPC, however this cohort of HPV-positive OPC and LPD patients had notably shorter long-term OS (58% at 5 years) than is typically reported for the HPV-positive OPC population. This data is useful in counseling patients with OPC and LPD co-diagnosis, and warrants further exploration in larger cohorts.