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Demographic and clinical characteristic of female patients with genital cGVHD

Introduction: Female genital chronic graft versus- host disease (fcGVHD) is an under- recognized and undertreated complication impacting quality of life of patients. It is reported to occur in a quarter of long-term female survivors. To determine clinical manifestations and their relation with severity of cGVHD in female patients with genital manifestations we prospectively analyzed a cohort of adult females who were enrolled on the cross-sectional cGVHD natural history study. Materials (or patients) and methods: A total of 130 consecutive female adult patients with cGVHD were assessed on this NCI protocol (clinicaltrials.gov identifier: NCT00331968) from 2004. to 2014. g. All patients were evaluated by an interdisciplinary team during four days visit. Detailed history, physical examination and laboratory analysis were done. Diagnosis of cGVHD was made according to NIH Consensus Group Criteria. NIH grading criteria was used to determine global cGVHD score as a measure of cGVHD severity. History related to genital issues, gynecology examination and special questionnaire related to demographic parameters, genital symptoms, hormonal therapy and sexual activity were performed. Diagnosis of genital cGVHD was made according to Stratton-Turner criteria. Descriptive statistics and Chi-square test for dichotomous variables were used in the statistical analysis. A P value o0, 05 was considered to be statistically significant. Results: Most frequent reason for allogeneic stem cell myeloic leukemia or myelodisplastic syndrome which were found in 66 (50.8%) patients. Myeloablative conditioning was performed in 70 (53, 8%) patients. In 105 patients (80, 8%) peripheral stem blood cells (PSBC) were used as stem source. Median age was 44.5 (range 18-70). Global cGVHD was severe in 97 (74, 6%) and moderate in 32 (24, 6%) patients. All patients had other organs involved. At the time of evaluation, 84 (64, 6%) patients had genital cGVHD. 53 (40, 8%) patients with genital cGVHD had severe genital changes (vaginal adhesions, shortened vagina). More than one third of patients with genital cGVHD (34.5%) did not have gynecological symptoms suggestive of genital cGVHD. There was no difference in age, frequency of myeloablative conditioning or cell source between patients with and without genital cGVHD. Patients with severe genital cGVHD were more likely to have severe global cGVHD score (P ¼ 0, 035). Conclusion: Genital cGVHD should be considered and gynecologic assessment performed in women with cGVHD even if they are asymptomatic. In this large series more than one third of women with genital cGHVD did not have any genital symptoms. Patients with severe global cGVHD stage are more likely to present with genital manifestations and deserve increased vigilance in evaluations.

chronic graft versus host disease ; female genital cGVHD

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