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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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.
