title: Female genital tract graft-versus-host disease: incidence, risk factors and recommendations for management.
abstract: Female genital tract graft-versus-host disease (GVHD) is an under-recognized complication of allogeneic stem cell transplantation impacting on quality of life. We describe a prospective surveillance programme for female genital GVHD to better characterize incidence, risk factors and clinical features and the impact of a structured intervention policy. A retrospective audit was conducted on the medical records of all female transplant recipients surviving at least 6 months at a single centre over a 5-year period. Patients commenced topical vaginal oestrogen early post transplant with hormone replacement as appropriate for age, prior menopausal status and co-morbidities. A genital tract management programme included regular gynaecological review and self-maintenance of vaginal capacity by dilator or intercourse. The incidence of genital GVHD was 35% (95% confidence interval (CI) (25, 50%)) at 1 year and 49% (95% CI (36, 63%)) at 2 years. Topical therapy was effective in most cases; no patient required surgical intervention to divide vaginal adhesions. The main risk factor was stem cell source with peripheral blood progenitor cells posing a higher risk than marrow (hazard ratio=3.07 (1.22, 7.73), P=0.017). Extensive GVHD in other organs was a common association. We conclude that female genital GVHD is common, and early detection and commencement of topical immunosuppression with dilator use appears to be highly effective at preventing progression.
authors.affiliation: Bone Marrow Transplant Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Zantomio
authors.forename: A P
authors.initials: AP
authors.lastname: Grigg
authors.forename: L
authors.initials: L
authors.lastname: MacGregor
authors.forename: Y
authors.initials: Y
authors.lastname: Panek-Hudson
authors.forename: J
authors.initials: J
authors.lastname: Szer
authors.forename: R
authors.initials: R
authors.lastname: Ayton
mesh_terms: D000287:Administration, Topical; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D019468:Disease Management; D005260:Female; D005831:Genital Diseases, Female / Q000188:drug therapy* / Q000209:etiology*; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015994:Incidence; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents