Vulvovaginal Graft-Versus-Host Disease

Kornik, Rachel; Rustagi, Alison S

doi:10.1016/j.ogc.2017.05.007

Cited by 18 publications

(17 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, a gynecological form of GVHD is an independent risk factor of HSIL [2]. The incidence of abnormal cytology in patients after allo-HCT reaches up to 40-70% according to different authors, which is many times higher than in a healthy population (4%) [2,10,14,17,18,27]. We present similar data in our study.…”

Section: Discussionsupporting

confidence: 88%

“…Secondly, 45% of patients had the highest (score 3) for female genital cGVHD according to the NIH recommendations, and even two patients were documented with partial or complete vaginal stenosis. The higher cGVHDgyn morbidity in our group than reported by others [7,14,17,18] (ranging between 25 and 60% depending on the criteria used) may result from some patient preselection since patients with gynecological symptoms were more likely to visit a dedicated gynecologist. High morbidity may also result from the peripheral blood stem cells used as a graft source in our patients, which is known to increase the risk of cGVHDgyn comparing with bone marrow transplantation grafts [7,14].…”

Section: Discussioncontrasting

confidence: 51%

“…Topical glucocorticosteroids serve as an essential component in the treatment of GVHDgyn [7,10,14,18]. Only some patients in our group received such treatment.…”

Section: Discussionmentioning

confidence: 92%

“…The median time of developing GVHDgyn after allo-HCT reported in the literature is 7-10 months [7,14,18]. In about 70% of patients, signs affect only the vulva, and in 30% both vulva and vagina, and vaginal symptoms usually appear after vulvar [14,18].…”

Section: Discussionmentioning

confidence: 99%

“…We could not verify the time of GVHDgyn development in our group, due to suboptimal gynecological care in the past; however, from 2018 prospective analysis has been launched in our center. Chronic GVHDgyn is almost always associated with cGVHD manifestation in other organs such as the skin, mouth, liver, or gastrointestinal tract [7,14,18]. Zantomio et al reported even 90% probability of GVHDgyn coexistence with other organ involvement, most often the mouth and skin [7].…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life experience

et al. 2020

View full text Add to dashboard Cite

In everyday gynecological practice, there is an unmet need to manage survivors after allogeneic hematopoietic cell transplantation (allo-HCT). The major gynecological complications include premature ovarian insufficiency (POI), chronic graft-versushost disease (cGVHD) of the anogenital zone (cGVHDgyn), and secondary neoplasms. Aiming to assess a real-life scale of problems associated with HCT, we performed a detailed analysis of a consecutive series of females after allo-HCT who were referred for a routine gynecological evaluation. The study includes 38 females after allo-HCT in whom gynecological examination with cervical smear and USG were performed, followed by colposcopy according to NCCN guidelines. NIH scoring system was used to classify a grade of cGVHDgyn. The incidence of cGVHD was 71% whereas GVHDgyn was 29%, including 5 patients with score 3 at the time of diagnosis. The other manifestations (frequently noted) included the skin, mucosa, eyes, and liver. Menopause was diagnosed in 93% females, and in 81% of them, POI criteria were fulfilled. Ovarian function resumed in 2 cases. The rate of abnormal cytology was 26%: 4 ASCUS, 1 AGUS, 1 LSIL, 3 HSIL/ASC-H, and one cytological suspicion of cervical cancer. GVHDgyn was documented in 10 patients, and 6 of them had abnormal cervical cytology. Early topical estrogen therapy led to a significant reduction in vaginal dryness (p < 0.05), dyspareunia (p < 0.05), and less frequent cGVHDgyn (p < 0.05). GVHDgyn develops in about 30% of long-term allo-HCT survivors. Topical estrogens and hormonal replacement therapy alleviate symptoms and prevent the occurrence of severe consequences of menopause.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussioncontrasting

confidence: 51%

“…Topical glucocorticosteroids serve as an essential component in the treatment of GVHDgyn [7,10,14,18]. Only some patients in our group received such treatment.…”

Section: Discussionmentioning

confidence: 92%