Abstract
Study Objective
To assess genital symptomatology, characterize the findings of genital examination,
and describe the incidence and treatment of vulvovaginal graft-versus-host disease
(vvGvHD) in girls and adolescents after allogeneic hematopoietic stem cell transplantation
(HSCT).
Design
Retrospective cohort.
Setting
Metropolitan-area children's hospital.
Participants
Female allogeneic HSCT recipients ages 0 to 22 years.
Main Outcome Measures
Genital symptoms, genital examination, diagnosis, and treatment of vvGvHD.
Results
A total of 57 participants were included in the analysis. The median age at the time
of HSCT was 10 years (range 4 months−23 years). Most (n = 40, 71%) underwent transplant for a nonmalignant condition, most commonly sickle
cell anemia (n = 19, 33%). The median time of onset of GvHD post HSCT was 62 days (IQR = 42 to 151
days). The most common initial site of GvHD was skin (n = 21, 64%), followed by GI tract (n = 10, 30%). Three patients (5%) were diagnosed with vvGvHD. The time of onset of
vvGvHD post HSCT ranged from 62 to 1565 days. One patient (33%) was asymptomatic at
the time of diagnosis. There was no difference in diagnosis of vvGvHD when race (P = 0.15), age at allogeneic HSCT (P = 0.64), nonmalignant vs malignant indication (P = 0.21), source of stem cells (P = 0.25), partial vs full human leukocyte antigens (HLA) donor match (P = 0.34), and GvHD prophylaxis regimen (P = 0.18) were compared. None had isolated vvGvHD. Vulvovaginal GvHD was preceded by
skin GvHD in 1 patient, was preceded by lung GvHD in 1 patient, and occurred concurrently
with skin GvHD in the third patient.
Conclusions
Pediatric vvGvHD can occur within the first 100 days after transplant and can be asymptomatic.
Routine gynecologic evaluation post allogeneic HSCT in children and adolescents should
include a thorough review of vulvovaginal symptoms and a gynecologic exam for the
detection and treatment of vvGvHD.
Keywords
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References
- Increasing incidence of chronic graft-versus-host disease in allogeneic transplantation: a report from the Center for International Blood and Marrow Transplant Research.Biol Blood Marrow Transplant. 2015; 21: 266-274
- Late acute and chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation.Biol Blood Marrow Transplant. 2016; 22: 449-455
- Alloreactivity: the Janus-face of hematopoietic stem cell transplantation.Leukemia. 2017; 31: 1752-1759
- Long-term physiological side effects after allogeneic bone marrow transplantation.Hematol Am Soc Hematol Educ Progr. 2010; 2010: 229-236
- Female genital tract chronic graft-versus-host disease: review of the literature.Anticancer Res. 2015; 35: 13-17
- A prospective study of female genital chronic graft-versus-host disease symptoms, signs, diagnosis and treatment.Acta Obstet Gynecol Scand. 2018; 97: 1122-1129
- Graft-versus-host disease of the vulva and/or vagina: diagnosis and treatment.Biol Blood Marrow Transplant. 2003; 9: 760-765
- Female genital tract graft-versus-host disease following allogeneic bone marrow transplantation.Haematologica. 2003; 88: 1163-1168
- Management and long-term consequences of genital graft versus host disease following hematopoietic stem cell transplantation.Bone Marrow Transplant. 2020; 55: 2234-2243
- Gynecologic manifestations of chronic graft-versus-host disease.Obstet Gynecol. 1982; 60: 488-492
- Clinical guidelines for gynecologic care after hematopoietic SCT. Report from the international consensus project on clinical practice in chronic GVHD.Bone Marrow Transplant. 2015; 50: 3-9
- Female genital chronic graft-versus-host disease: importance of early diagnosis to avoid severe complications.Transplantation. 2012; 93: 1265-1269
- Female long-term survivors after allogeneic hematopoietic stem cell transplantation: evaluation and management.Semin Hematol. 2012; 49: 83-93
- Gynecological abnormalities following allogeneic bone marrow transplantation.Bone Marrow Transplant. 1990; 5: 425-430
- Female genital tract graft-versus-host disease: incidence, risk factors and recommendations for management.Bone Marrow Transplant. 2006; 38: 567-572
- Graft-versus-host disease-associated vulvovaginal symptoms after bone marrow transplantation.Biol Blood Marrow Transplant. 2016; 22: 378-379
- Vulvovaginal chronic graft-versus-host disease with allogeneic hematopoietic stem cell transplantation.Obstet Gynecol. 2007; 110: 1041-1049
- National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report.Biol Blood Marrow Transplant. 2015; 21 (e381): 389-401
- Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation.Bone Marrow Transplant. 2012; 47: 337-341
- Pediatric and young adult vulvovaginal graft-versus-host disease.Biol Blood Marrow Transplant. 2019; 25: 2408-2415
- Patterns of genital examination and vulvovaginal graft-versus-host disease in a pediatric post-hematopoietic stem cell transplant population.J Pediatr Adolesc Gynecol. 2020; 33: 658-666
- Incidence, clinical outcome, and management of virus-induced hemorrhagic cystitis in children and adolescents after allogeneic hematopoietic cell transplantation.Biol Blood Marrow Transplant. 2005; 11: 797-804
- A prospective study on the predictive value of plasma BK virus-DNA load for hemorrhagic cystitis in pediatric patients after stem cell transplantation.J Pediatr Infect Dis Soc. 2015; 4: 134-142
- The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation-a single-center real-life experience.Ann Hematol. 2020; 99: 1361-1368
- Resolution of hematocolpos in adolescents affected with graft vs host disease.J Pediatr Adolesc Gynecol. 2018; 31: 536-539
Article info
Publication history
Published online: April 23, 2022
Accepted:
April 14,
2022
Received in revised form:
April 4,
2022
Received:
October 11,
2021
Identification
Copyright
Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology.
