Wilk Goldsher Yulia, Cohen Sacher Bina, Cohen May, Yeshurun Moshe, Sabah Gad, Eitan Ram, Krissi Haim
Department of Obstetrics and Gynecology, The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.
Faculty of Medical and Health Sciences, Tel Aviv Univesity, Tel Aviv, Israel.
Ann Hematol. 2025 Jan;104(1):773-779. doi: 10.1007/s00277-025-06224-1. Epub 2025 Jan 28.
Chronic Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (HSCT), affecting the female genital tract in 25-66% of the patients. This condition, referred to as Genital GVHD is an underdiagnosed gynecologic comorbidity, that can significantly impair quality of life. We aimed to describe the prevalence and management of genital GVHD following HSCT. This retrospective analysis included women who underwent allogeneic HSCT at a single Bone Marrow Transplantation Unit between 2015 and 2020 and were evaluated at a specialized Vulvo-Vaginal Clinic. Diagnosis and severity of genital GVHD were based on the recommendations by the National Institute of Health (NIH), therapeutic options included topical treatments and surgical interventions. Of the thirty-six patients evaluated, 19.4% were diagnosed with genital GVHD. Patients with genital GVHD were older than those with no-genital GVHD (58.42 vs 47.48 years, p = 0.02), and most of them had concurrent multi-organ chronic GVHD (85.71%). Genital GVHD was mostly symptomatic in our cohort (71.42%), clinical findings at the time of diagnosis corresponded with NIH grade 3 (severe disease) in 57.1% of cases. Topical treatments were initiated for all patients with genital GVHD, one required surgical intervention. Genitourinary syndrome of menopause (GSM) was diagnosed among 100% of patients with genital GVHD and among 58.62% of patients without genital GVHD (p = 0.08). In the genital GVHD group, adherence to clinical follow up was limited (43.85%). Genital GVHD should be considered as part of chronic GVHD evaluation after allogeneic HSCT. It is associated with advanced age and the presence of chronic systemic GVHD. Impaired quality of life and limited follow-up within this population emphasize the need for increased awareness and early evaluations.
慢性移植物抗宿主病（GVHD）是异基因造血干细胞移植（HSCT）的主要并发症，25%-66%的患者会累及女性生殖道。这种情况被称为生殖器GVHD，是一种诊断不足的妇科合并症，会显著损害生活质量。我们旨在描述HSCT后生殖器GVHD的患病率及管理情况。这项回顾性分析纳入了2015年至2020年间在单一骨髓移植单元接受异基因HSCT并在专门的外阴-阴道诊所接受评估的女性。生殖器GVHD的诊断和严重程度依据美国国立卫生研究院（NIH）的建议，治疗选择包括局部治疗和手术干预。在接受评估的36例患者中，19.4%被诊断为生殖器GVHD。患有生殖器GVHD的患者比未患生殖器GVHD的患者年龄更大（58.42岁对47.48岁，p = 0.02），且大多数患者同时患有多器官慢性GVHD（85.71%）。在我们的队列中，生殖器GVHD大多有症状（71.42%），57.1%的病例在诊断时的临床发现符合NIH 3级（严重疾病）。所有生殖器GVHD患者均开始接受局部治疗，1例需要手术干预。100%的生殖器GVHD患者和58.62%的非生殖器GVHD患者被诊断出绝经泌尿生殖综合征（GSM）（p = 0.08）。在生殖器GVHD组中，临床随访的依从性有限（43.85%）。生殖器GVHD应被视为异基因HSCT后慢性GVHD评估的一部分。它与高龄和慢性全身性GVHD的存在有关。该人群生活质量受损且随访有限，这凸显了提高认识和早期评估的必要性。
