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A prospective study of female genital chronic graft-versus-host disease symptoms, signs, diagnosis and treatment

Journal article
Authors Eva Smith Knutsson
Yvonne Björk
A. K. Broman
L. Helstrom
Malin Nicklasson
Mats Brune
Karin Sundfeldt
Published in Acta Obstetricia Et Gynecologica Scandinavica
Volume 97
Issue 9
Pages 1122-1129
ISSN 0001-6349
Publication year 2018
Published at Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 1122-1129
Language en
Links dx.doi.org/10.1111/aogs.13366
Keywords Allogeneic hematopoietic stem cell transplantation, chronic graft-versus-host disease, diagnostic, bone-marrow-transplantation, stem-cell transplantation, consensus, development project, working group-report, clinical-trials, management, tacrolimus, survivors, criteria, Obstetrics & Gynecology
Subject categories Obstetrics, Gynecology and Reproductive Medicine, Internal medicine

Abstract

IntroductionFemale genital chronic graft-versus-host disease (cGvHD) is a complication of allogeneic hematopoietic cell transplantation (alloHCT) for blood malignancies. Unattended inflammation and fibrosis in the vulva andvagina may lead to total vaginal stenosis. The course and treatment of genital cGvHD was observed in this population-based prospective study. Material and methodsWomen (n=41) receiving alloHCT in 2005-10 were examined before and at 3, 6, 9, 12, 18, 24, 30 and 36months post-transplant. Vulvovaginal signs were documented, National Institutes of Health clinical scores were calculated, and women completed questionnaires on symptoms, the Female Sexual Distress Scale and the Beck Depression Inventory. Local immunosuppressive treatment was given weekly. ResultsGenital cGvHD was diagnosed in 27 women (incidence 56% at 12months; 66% at 36months); extragenital cGvHD was found in 21/27. The most common signs at diagnosis were red and white spots, reticular white lines, fissures, synechiae and telangiectasia; symptoms included dryness, itching, dyspareunia, pain or no symptoms. Thirteen women were treated on a schedule of tacrolimus and clobetazol ointments. Although some signs progressed during treatment, only two women developed total stenosis. At 36months, 12 women still had genital cGvHD. ConclusionsGenital cGvHD develops mainly in the first year after alloHCT. Early intervention may halt its progress to severe fibrosis, but despite correct diagnosis and treatment, symptoms and signs may become chronic. Women who develop genital cGvHD following alloHCT require life-long gynecological supervison and care.

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