1. ¹Bone Marrow Transplant Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
2. ²Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
3. ³Menopause Clinic, Royal Women's Hospital, Carlton, Victoria, Australia

Correspondence: Dr J Szer, Bone Marrow Transplant Service, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia. E-mail: jeff.szer@mh.org.au

Received 10 April 2006; Revised 24 July 2006; Accepted 25 July 2006; Published online 4 September 2006.

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.