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Published on: February 11, 2019
VULVO-Vaginal Chronic Graft-Versus-Host Disease Assessment: A Single-Center Prospective Observational Study
Francesca Palmisano1, Chiara Cannici1, Rita Tavarozzi1,2
1Hematology Department, SS Antonio & Biagio and C. Arrigo University Hospital, Alessandria, Italy.
Insights
Vulvovaginal chronic graft-versus-host disease (vv-cGvHD) affects nearly 30% of female HSCT patients. Early detection and management are crucial for improving quality of life and preventing severe complications.
Area of Science:
- Hematology
- Oncology
- Gynecology
Background:
- Vulvovaginal chronic graft-versus-host disease (vv-cGvHD) is an underrecognized complication following allogeneic hematopoietic stem cell transplantation (HSCT).
- It can significantly impact sexual function, quality of life, and long-term patient morbidity.
- Limited prospective data exist regarding systematic gynecological assessment for vv-cGvHD.
Purpose of the Study:
- To evaluate the 1-year incidence and clinical features of vv-cGvHD in female patients post-HSCT.
- To assess the impact of vv-cGvHD using standardized gynecological examinations and patient-reported outcomes.
Main Methods:
- Prospective, observational, single-center study involving female patients alive and relapse-free at day +100 post-HSCT.
- Standardized gynecological examinations performed at baseline, day +100, 6 months, and 12 months.
- Patient-reported outcomes collected via a symptom-focused questionnaire.
Main Results:
- The 1-year cumulative incidence of vv-cGvHD was 30% (12/41 patients), with 6 cases of grade 1 and 6 of grade 2.
- Half of affected patients had isolated genital involvement.
- Median onset was 6 months post-transplant; other organ GvHD was the only associated factor (p=0.02).
- Topical corticosteroids and hyaluronic acid were effective treatments, preventing progression to severe disease.
Conclusions:
- vv-cGvHD occurs with considerable frequency in HSCT recipients.
- Systematic screening and established management protocols are essential for this patient population.
Background:
Vulvovaginal chronic graft-versus-host disease (vv-cGvHD) is an underrecognised complication after allogeneic haematopoietic stem cell transplantation (HSCT), with potential impact on sexual function, quality of life, and long-term morbidity. Few prospective data are available in the literature based on systematic gynaecological assessment.
Material And Methods:
A prospective, observational, single-centre study was carried out to evaluate 1-year incidence and clinical features of vv-cGvHD in female patients undergoing HSCT among patients alive and relapse-free at day + 100. Standardised gynaecological examinations were performed at baseline, day + 100, 6, and 12 months. Data collection included patient-reported outcomes by use of a symptom-focused questionnaire to assess the presence and impact of vv-cGvHD.
Results:
Forty-one evaluable patients were included in the analysis and followed with scheduled gynaecological evaluations at defined intervals post-transplant. Vv-cGvHD was diagnosed in 12 out of 41 patients (29.3%), with six cases classified as grade 1 and six as grade 2 according to NIH criteria. The conditional cumulative incidence at 1 year was 30%. Half of the affected patients presented isolated genital involvement, without other cGvHD manifestations. Median onset was 6 months post-transplant. Chronic GvHD in other organs was the only factor associated with vv-cGvHD in univariate analysis (p = 0.02). Topical treatment with corticosteroids and hyaluronic acid was administered to 75% (n = 9) of affected patients, with no cases progressing to severe disease requiring surgical intervention.
Conclusion:
This study highlights a considerable incidence of vv-cGvHD among HSCT recipients, underlining the need for systematic screening and management protocols.
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