title: Severe vaginal chronic graft-versus-host disease (GVHD): two cases with late onset and literature review.
abstract: Female genital graft-versus-host disease (GVHD) occurs after allogenic stem cell transplantation (SCT) in 25% of long-term survivors. To date, 28 severe cases with hematocolpos requiring surgery have been documented. We report two cases of severe gynecological GVHD. Although most of the vaginal GVH disease cases occurred within two years after oncologic treatment, our two cases highlight the possibility of a very long onset. We also confirmed that hormonal replacement therapy does not protect against synechia and that corticoid treatment has a good therapeutic value in recurrence after surgery. In conclusion, women with SCT experience a high risk of vaginal GVHD that could impair quality of life and sexual function. These cases pinpointed the importance of very long-term gynecological follow-up in order to diagnose early symptoms. To date, only early therapy with local corticoid application might reduce symptoms and development of severe genital GVHD. We support systematic use of topical corticoid therapy in severe cases even after surgery because of the high incidence of recurrence.
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital Civil de Charleroi, Charleroi, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Riera
authors.forename: Y
authors.initials: Y
authors.lastname: Deroover
authors.forename: M
authors.initials: M
authors.lastname: Marechal
mesh_terms: D000328:Adult; D005260:Female; D005836:Genitalia, Female / Q000473:pathology; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007938:Leukemia / Q000628:therapy; D012720:Severity of Illness Index; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014623:Vaginal Diseases / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents