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Management and long-term consequences of genital graft versus host disease following hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 55, pages 2234–2243 (2020)Cite this article

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Abstract

Vulvovaginal Graft-versus-host disease (VV-GVHD) is an underdiagnosed complication of hematopoietic stem cell transplantation (HSCT). The severity of the disease varies greatly, ranging from minor discomfort to severe, irreversible anatomic changes. This study sought to assess the long-term course of VV-GVHD. A retrospective analysis was conducted of 64 women who underwent HSCT and were followed over 9 years in a designated vulvovaginal clinic. VV-GVHD was detected in 56% of transplanted women. Adherence with follow-up correlated with diagnosis of VV-GVHD (p < 0.001) and with sexual activity (p = 0.023). Most of the women with VV-GVHD were symptomatic; however, 22% were asymptomatic upon diagnosis. Women were treated with topical steroids, topical estrogen, vaginal dilators, and vaginal silicone rings. Vaginal silicone rings were associated with higher patient adherence and better results. VV-GVHD is a common complication of HSCT and can adversely impact patients’ sexuality and quality of life. The disease pattern is chronic, necessitating long term follow-up and adherence with treatment. Vulvar anatomical changes occurred despite treatment; however, vaginal patency can be maintained by early diagnosis, constant surveillance, and early treatment, consequently allowing preservation of normal sexual function. Awareness of VV-GVHD must be raised in order to better serve female patients and facilitate early diagnosis and treatment.

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Fig. 1: Gynecological Follow-Up.
Fig. 2: Cumulative incidence of chronic VV-GVHD.
Fig. 3: Self-reported symptoms.
Fig. 4: Vulvar findings of graft versus host disease.

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Author notes

  1. These authors contributed equally: Sigal Grisariu, Batia Avni

Authors and Affiliations

  1. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Ahinoam Lev-Sagie, Ela Adar-Walling, Sigal Grisariu & Batia Avni

  2. Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel

    Ahinoam Lev-Sagie, Ela Adar-Walling & Arielle Gumer

  3. Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel

    Sigal Grisariu & Batia Avni

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  1. Ahinoam Lev-Sagie
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Correspondence to Ahinoam Lev-Sagie.

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Lev-Sagie, A., Adar-Walling, E., Gumer, A. et al. Management and long-term consequences of genital graft versus host disease following hematopoietic stem cell transplantation. Bone Marrow Transplant 55, 2234–2243 (2020). https://doi.org/10.1038/s41409-020-0933-2

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