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

作者：Knutsson Eva Smith; Bjork Yvonne; Broman Anna Karin; Helstrom Lotti; Nicklasson Malin; Brune Mats; Sundfeldt Karin^*

来源：Acta Obstetricia et Gynecologica Scandinavica, 2018, 97(9): 1122-1129.

DOI：10.1111/aogs.13366

• Allogeneic hematopoietic stem cell transplantation
• chronic graft-versus-host disease
• diagnostic
• dyspareunia
• genital chronic graft-versus-host disease
• sexual dysfunction
• treatment

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.

• 出版日期2018-9