title: Female genital chronic graft-versus-host disease: importance of early diagnosis to avoid severe complications.
abstract: BACKGROUND
  Genital chronic graft-versus-host disease (GVHD) is a frequent but underdiagnosed complication of allogeneic stem-cell transplantation impairing quality of life.
  
  
  METHODS
  We identified 32 female patients with genital chronic GVHD (cGVHD) who underwent allogeneic hematopoietic stem-cell transplantation in our center between 2000 and 2010 and who were followed after transplantation in a specialized gynecological consultation. Pre- and posttransplantation clinical data and detailed acute and cGVHD data were collected. All patients received the same local treatment for genital lesions.
  
  
  RESULTS
  At presentation, most patients complained about vaginal dryness and dyspareunia with impairment in sexual activity. Fifty percent of patients had grade I genital lesions and 50% had grade II or III lesions. Patients seen later in gynecological consultation had more severe lesions than patients seen early after transplantation. At the time of diagnosis, most patients had other cutaneous or mucous localizations of cGVHD. In most cases, lesions were stabilized or decreased with local steroids and estrogen treatment, and most patients could resume sexual activity. Treatment was more efficient in patients with mild lesions than in others.
  
  
  CONCLUSIONS
  Genital cGVHD should be systematically searched for in women who have received allogeneic hematopoietic stem-cell transplantation in an early specialized consultation, especially in case of other cutaneous or mucous localizations of cGVHD. Local treatment associating steroids and estrogen seemed to prevent further evolution of grade I genital lesions and to avoid surgical treatment.
authors.affiliation: Service d'Hématologie-Greffe, Hôpital Saint-Louis, APHP, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Hirsch
authors.forename: Mathieu
authors.initials: M
authors.lastname: Leclerc
authors.forename: Michel
authors.initials: M
authors.lastname: Rybojad
authors.forename: Anna D
authors.initials: AD
authors.lastname: Petropoulou
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.forename: Régis Peffault
authors.initials: RP
authors.lastname: de la Tour
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Cavelier-Balloy
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Dominique
authors.initials: D
authors.lastname: Vexiau-Robert
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D042241:Early Diagnosis; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology; D019337:Hematologic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D004967:Estrogens; D013256:Steroids