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Martínez-Maestre MÁ, Castelo-Branco C, Calderón AM, Espigado I, Pérez-Simón JA, González-Cejudo C. Genital chronic graft-versus-host disease: an unmet need that requires trained gynecologists. Climacteric 2024; 27:275-281. [PMID: 38415712 DOI: 10.1080/13697137.2024.2314521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Menopause and chronic graft-versus-host disease (cGvHD) are the leading causes of morbidity after allogeneic hematopoietic stem cell transplantation (alloHSCT). Genitalia are one of the target organs of cGvHD causing sexual dysfunction and local symptoms, which may impair women's quality of life. The aim of this study is to describe the prevalence and clinical characteristics of genital cGvHD. METHODS A retrospective cross-sectional observational study was performed including 85 women with alloHSCT. All women were diagnosed and counseled by a trained gynecologist. Health-related quality of life was assessed by the Cervantes Short-Form Scale and sexual function was evaluated by the Female Sexual Function Index. RESULTS Seventeen women (20%) included in the study were diagnosed with genital cGvHD. The main complaints were vulvovaginal dryness (42.2%) and dyspareunia (29.4%), the presence of erythema/erythematous plaques (52.9%) being the most frequent sign. Median time from transplant to diagnosis of genital cGvHD was 17 months among those with mild involvement, 25 months for moderate and 42 months for severe forms. Mortality was 29.4% in patients who developed cGvHD with genital involvement versus 8.8% among those without (p = 0.012). CONCLUSION Early gynecological evaluation might allow to identify patients with mild forms of genital cGvHD, potentially enabling better management and improved outcomes.
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Affiliation(s)
| | - C Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A M Calderón
- Department of Gynecology, Virgen del Rocío University Hospital, Seville, Spain
| | - I Espigado
- Department of Haematology, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS), CSIC, University of Seville, Seville, Spain
| | - J A Pérez-Simón
- Department of Haematology, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS), CSIC, University of Seville, Seville, Spain
| | - C González-Cejudo
- Department of Gynecology, Virgen del Rocío University Hospital, Seville, Spain
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2
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Ganesan K, Duraisamy S, Meena SK, Yenigalla N, Swaminathan VV, Uppuluri R, Raj R. Genital Graft-versus-Host Disease in Children: An Underdiagnosed and Undertreated Entity. Transplant Cell Ther 2024; 30:228.e1-228.e5. [PMID: 37926190 DOI: 10.1016/j.jtct.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/09/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
Genital graft-versus-host disease (GVHD) is an underdiagnosed and poorly recognized complication, especially in the pediatric population. We report our data on children with genital manifestations of GVHD and their unique clinical features. The study included children up to age 18 years who underwent hematopoietic stem cell transplantation (HSCT) over a 20-year period from February 2002 to February 2022. A total of 1035 children underwent HSCT during the study period. Genital GVHD was documented in 164 children (15.8%). Among these 164 children, 23 (14%) were age <2 years, 98 (59.8%) were age 2 to 10 years, and 43 (26.2%) were age ≥10 years. The conditioning regimen was myeloablative in 122 children (74.4%) and reduced intensity in 42 children (25.6%). Donor type was matched related donor in 62 (37.8%), matched unrelated donor in 44 (26.8%), and haploidentical in 34 (20.7%). Peripheral blood stem cells (PBSCs) were used in 78.7% of the children (n = 129), and sex mismatch was noted in 31.1% of genital GVHD cases (51 of 164). The overall incidence of chronic oral GVHD was 33% (342 of 1035), and of these, 47.9% (164 of 342) also had genital GVHD. Patients with genital GVHD ultimately may require surgical management; 21.5% (22 of 103) of boys with genital GVHD ultimately required circumcision for phimosis, and 1 female patient developed hematocolpos necessitating surgical management. Our case series highlights the significant association between chronic oral GVHD and genital GVHD. Given the strong association between oral GVHD and genital GVHD in children, it is imperative to examine the genital area in all children on follow-up for chronic GVHD. Donor-recipient sex mismatch and use of PBSC grafts predispose to chronic genital GVHD. Early identification and treatment of genital GVHD may help prevent complications, including scarring and phimosis.
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Affiliation(s)
- Kavitha Ganesan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India.
| | - Suresh Duraisamy
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Satish Kumar Meena
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Navyasri Yenigalla
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | | | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
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Baumrin E, Loren AW, Falk SJ, Mays JW, Cowen EW. Chronic graft-versus-host disease. Part I: Epidemiology, pathogenesis, and clinical manifestations. J Am Acad Dermatol 2024; 90:1-16. [PMID: 36572065 PMCID: PMC10287844 DOI: 10.1016/j.jaad.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Chronic graft-versus-host disease is a major complication of allogeneic hematopoietic cell transplantation and a leading cause of long-term morbidity, nonrelapse mortality, and impaired health-related quality of life. The skin is commonly affected and presents heterogeneously, making the role of dermatologists critical in both diagnosis and treatment. In addition, new clinical classification and grading schemes inform treatment algorithms, which now include 3 U.S. Food and Drug Administration-approved therapies, and evolving transplant techniques are changing disease epidemiology. Part I reviews the epidemiology, pathogenesis, clinical manifestations, and diagnosis of chronic graft-versus-host disease. Part II discusses disease grading and therapeutic management.
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Affiliation(s)
- Emily Baumrin
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Alison W Loren
- Blood and Marrow Transplant, Cell Therapy and Transplant Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sandy J Falk
- Adult Survivorship Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jacqueline W Mays
- Oral Immunobiology Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
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Baumrin E, Loren AW, Falk SJ, Mays JW, Cowen EW. Chronic graft-versus-host disease. Part II: Disease activity grading and therapeutic management. J Am Acad Dermatol 2024; 90:19-36. [PMID: 36572064 PMCID: PMC10287839 DOI: 10.1016/j.jaad.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Chronic graft-versus-host disease (cGVHD) is a major complication of allogeneic hematopoietic cell transplantation and a leading cause of long-term morbidity, nonrelapse mortality, and impaired health-related quality of life. The skin is commonly affected and presents heterogeneously, making the role of dermatologists critical in both diagnosis and treatment. In addition, new clinical classification and grading schemes inform treatment algorithms, which now include 3 Federal Drug Administration-approved therapies, and evolving transplant techniques are changing disease epidemiology. Part I reviews the epidemiology, pathogenesis, clinical manifestations, and diagnosis of cGVHD. Part II discusses disease grading and therapeutic management.
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Affiliation(s)
- Emily Baumrin
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Alison W Loren
- Blood and Marrow Transplant, Cell Therapy and Transplant Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sandy J Falk
- Adult Survivorship Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jacqueline W Mays
- Oral Immunobiology Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
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5
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Preston M, Richards A. Vulvar and Vaginal Graft Versus Host Disease After Allogeneic Stem Cell Transplant-A Systematic Review. J Low Genit Tract Dis 2023; 27:266-274. [PMID: 37379441 DOI: 10.1097/lgt.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To conduct a systematic literature search to identify and determine the prevalence, signs and symptoms, and clinical management of vulvar and vaginal graft versus host disease (GVHD). METHODS A systematic literature search of articles from 1993 to August 2022 was performed. Studies were included if full text was available in the English language and provided reports on female subjects with more than four patients. Review articles, conference abstracts, case reports, and case series of less than 5 patients were excluded. Included studies had their reference list searched for further manuscripts. Two authors reviewed the search results and independently identified studies that met the selection criteria and summarized available data. RESULTS There were 29 studies available in the literature that met the inclusion criteria. There was a high risk of bias within the available literature. The prevalence of vulval and vaginal GVHD varied between 27% and 66% of women after allogeneic stem cell transplant. Other organ GVHD, most commonly the skin, mouth, and eyes, may be present concurrently in these patients, or they may be asymptomatic. Specialist gynecology review, topical estrogen, topical steroids, topical immunosuppression, and vaginal dilatation led to a reduction in complications associated with the condition, and surgery was helpful in some severe refractory cases. These patients remain at higher risk of developing cervical dysplasia, and regular human papillomavirus screening is recommended. CONCLUSIONS Female genital GVHD is a rare phenomenon. Early, coordinated, and regular gynecological reviews after stem cell transplant are essential to reduce the long-term complications.
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Affiliation(s)
- Marta Preston
- Obstetrics and Gynaecology Department, Sunshine Hospital, Western Health, St Albans, Victoria, Australia
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Graft-Versus-Host Disease Associated Post-operative Complications After Pelvic Reconstructive Surgery: A Case Report. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-11594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Graft-versus-host disease (GVHD) can occur after allogeneic bone marrow transplantation (BMT) and can affect the skin, gastrointestinal tract, lungs, liver, and vulvovaginal areas. Case Presentation: This case report described a 65-year-old multiparous patient with myelodysplastic syndrome who underwent a matched unrelated donor transplant approximately 3 years before her surgery. After her BMT she developed GVHD. She underwent anterior and posterior repair and uterosacral ligament suspension for stage III post-hysterectomy vaginal vault prolapse. Her postoperative course was complicated by mental status changes, abnormal liver function tests, and increasing abdominal distention. All her post-operative symptoms were resolved with conservative management. Conclusions: This case presentation highlights the potential atypical post-operative course of BMT patients with GVHD. The management of patients with GVHD relies heavily on the early involvement of hematologists.
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Alsuliman T, Jondreville L, Baylet C, Dann MP, De Bentzmann N, Fontoura ML, Genty C, Huynh A, Ibled D, Yakoub-Agha I, Mercier L, Poirot C, Porcheron S, Tourette-Turgis C, Vernant JP, Vexiau-Robert D, Nguyen S. Sexual and Emotional Health after Allogeneic Hematopoietic Cell Transplantation: A Comprehensive Review and Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC). J Clin Med 2022; 11:jcm11051196. [PMID: 35268291 PMCID: PMC8911485 DOI: 10.3390/jcm11051196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
A person’s sexual and emotional life is greatly impacted after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This topic is not addressed very much by patients and caregivers. Physical, endocrine and genital chronic graft versus host disease (cGVHD)-related disorders are multiple and intertwined with psychological disorders. The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) has issued recommendations for a better gynecological monitoring of female recipients after allo-HCT. A patient booklet was also offered to patients in the form of questions and answers to facilitate discussions between patients and caregivers and to improve the management of sexual and emotional life after transplant.
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Affiliation(s)
- Tamim Alsuliman
- Service d’Hématologie et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 184 Rue de Faubourg Saint-Antoine, 75012 Paris, France;
| | - Ludovic Jondreville
- Service d’Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Boulevard de l’Hôpital, CEDEX 13, 75651 Paris, France; (L.J.); (M.-P.D.); (D.I.); (J.-P.V.)
| | - Caroline Baylet
- Service des Maladies du Sang, CHU Angers, 4 Rue Larrey, 49000 Angers, France;
| | - Marie-Pierre Dann
- Service d’Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Boulevard de l’Hôpital, CEDEX 13, 75651 Paris, France; (L.J.); (M.-P.D.); (D.I.); (J.-P.V.)
| | - Natacha De Bentzmann
- Service d’Hématologie Greffe, IUCT-Oncopole, 1 Avenue Irène Joliot Curie, CEDEX 9, 31059 Toulouse, France; (N.D.B.); (A.H.); (L.M.)
| | - Marie-Laure Fontoura
- Unité de Soins Intensifs Hématologie, CLCC Henri Becquerel, 1 Rue d’Amiens, 76038 Rouen, France; (M.-L.F.); (S.P.)
| | - Carole Genty
- Service d’Hématologie et de Thérapie Cellulaire, CHRU Dupuytren, 2 Avenue Martin Luther King, 87042 Limoges, France;
| | - Anne Huynh
- Service d’Hématologie Greffe, IUCT-Oncopole, 1 Avenue Irène Joliot Curie, CEDEX 9, 31059 Toulouse, France; (N.D.B.); (A.H.); (L.M.)
| | - Diane Ibled
- Service d’Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Boulevard de l’Hôpital, CEDEX 13, 75651 Paris, France; (L.J.); (M.-P.D.); (D.I.); (J.-P.V.)
| | | | - Lara Mercier
- Service d’Hématologie Greffe, IUCT-Oncopole, 1 Avenue Irène Joliot Curie, CEDEX 9, 31059 Toulouse, France; (N.D.B.); (A.H.); (L.M.)
| | - Catherine Poirot
- Préservation de la Fertilité, Service d’Hématologie, Unité AJA, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Médecine Sorbonne Université, Site Pitié Salpêtrière, 91 Bd de l’Hôpital, 75013 Paris, France
| | - Sophie Porcheron
- Unité de Soins Intensifs Hématologie, CLCC Henri Becquerel, 1 Rue d’Amiens, 76038 Rouen, France; (M.-L.F.); (S.P.)
| | | | - Jean-Paul Vernant
- Service d’Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Boulevard de l’Hôpital, CEDEX 13, 75651 Paris, France; (L.J.); (M.-P.D.); (D.I.); (J.-P.V.)
| | | | - Stéphanie Nguyen
- Service d’Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Boulevard de l’Hôpital, CEDEX 13, 75651 Paris, France; (L.J.); (M.-P.D.); (D.I.); (J.-P.V.)
- Correspondence:
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Smith Knutsson E, Nicklasson M, Björk Y, Stenberg K, Sundfeldt K, Brune M. Late follow-up of genital and ophthalmologic chronic graft-versus-host disease in females after allogeneic stem cell transplantation. Acta Obstet Gynecol Scand 2021; 101:364-373. [PMID: 34962288 DOI: 10.1111/aogs.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/30/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Genital chronic graft-versus-host disease (cGvHD) is a common late effect after allogeneic stem cell transplantation. In a previous cross-sectional study, prevalence, signs and symptoms of genital and extra-genital cGvHD were accounted for in a cohort of 42 women. Classifications of cGvHD were performed as per the National Institutes of Health (NIH) 2005 criteria. In this follow-up study on surviving women, the aim was to assess genital and extra-genital cGvHD status after long period of time. Our hypothesis was that signs and symptoms of cGvHD alleviate over time. MATERIAL AND METHODS All surviving women (n = 38) were re-examined by an ophthalmologist, a gynecologist and a hematologist. Signs and symptoms were classified according to the NIH 2014 criteria. Clinical scorings of affected organs were combined for estimating global score of cGvHD. To make possible comparisons between the two studies, data from the original study were re-classified as per the NIH 2014 criteria, and the four dead women were excluded. The same questionnaires were completed. Cervical smear, human papilloma virus test and vulvar photo-documentation were performed. RESULTS Median time after original study was 8.4 (5.8-12) years and after transplant 14.5 (10-19.3) years. The prevalence of genital cGvHD was similar in the original (50%) and follow-up (58%) studies (p = 0.646) as well as extra-genital cGvHD. Systemic corticosteroid treatment of cGvHD was ongoing in 34% and 29%, respectively (p = 0.805). Ocular cGvHD was found in 24 of 37 examined women (65%) in the follow-up study. Genital cGvHD had disappeared in three women and developed in two women 5-12 and 9-17 years, respectively, after transplantation. The severity of global cGvHD changed over time in 14 women, but was the same on group level (p = 0.345). Atrophic mucous membranes as in estrogen deficiency were seen in 66%. Three women had human papilloma virus genotypes associated with the risk of developing cervical cancer. CONCLUSIONS Chronic GvHD did not alleviate over time. Allotransplanted women require early and continuous life-long contact with a gynecologist and an ophthalmologist for the detection of cGvHD. Specific attention should be given to the need for local estrogen and the risk of genital epithelial malignancies.
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Affiliation(s)
- Eva Smith Knutsson
- Department of Obstetrics and Gynecology, NU Hospital Group, Trollhättan, Sweden.,Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Malin Nicklasson
- Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Sahlgrenska, Gothenburg, Sweden
| | - Yvonne Björk
- Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Sahlgrenska, Gothenburg, Sweden
| | - Kristina Stenberg
- Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Karin Sundfeldt
- Department Obstetrics and Gynecology, Institution for Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mats Brune
- Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Sahlgrenska, Gothenburg, Sweden
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Graft-versus-host disease in the female genital tract: a prospective cohort study. Arch Gynecol Obstet 2021; 305:1551-1558. [DOI: 10.1007/s00404-021-06330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
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10
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Meet the expert: Topical management of vulvar dermatoses. J Geriatr Oncol 2021; 13:282-286. [PMID: 34824022 DOI: 10.1016/j.jgo.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/26/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022]
Abstract
Vulvar dermatoses are often debilitating chronic skin conditions associated with pain and pruritus. In oncologic patients, cancer treatments can precipitate and exacerbate vulvar dermatoses. Cytotoxic chemotherapy, hormonal therapies, and local pelvic radiation therapy can lead to vulvar symptoms, and cancer treatment-induced vulvar conditions include graft-versus-host-disease and radiation dermatitis. There have also been reports of lichen sclerosus development or exacerbation secondary to hormonal therapy and immune checkpoint inhibitors, attributed to proposed hormonal and immunologic pathogenesis of lichen sclerosus. Early recognition and treatment of these conditions can significantly improve quality of life. In this review, we summarize the clinical features and management characteristics of six types of common vulvar dermatoses that may present in the oncologic patient.
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Ten Hagen PL, Bowe C, Dains JE. Early Detection of Vulvovaginal Graft-Versus-Host Disease: An Integrative Review. J Adv Pract Oncol 2021; 12:725-737. [PMID: 34671502 PMCID: PMC8504929 DOI: 10.6004/jadpro.2021.12.7.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Vulvovaginal graft-vs.-host disease (VVGvHD) is a condition caused by a T-cell mounted immune response after allogeneic hematopoietic stem cell transplant (alloHSCT), which can lead to sclerotic changes of the external genital organs. A common complication of alloHSCT, VVGvHD is underreported and underdiagnosed in female patients. Without detection and treatment, VVGvHD can progress to complete obliteration of the vaginal canal requiring surgical intervention in severe cases. Design: This review summarizes findings to assist providers in detecting and treating VVGvHD. It utilized PubMed, Scopus, and CINAHL databases. Inclusion criteria consisted of female patients, a history of stem cell transplantation, and a history of VVGvHD. Studies not published in English and dated more than 15 years were excluded. After the evaluation of 333 articles, 10 were included based on relevance and applicability. Limitations of this review included small sample sizes, retrospective nature of articles, and lack of randomized control trials. Findings: Early identification of VVGvHD requires identifying the rate of occurrence and risk factor profile, recognizing the presenting symptoms, improving VVGvHD assessment techniques, ascertaining when to biopsy, and establishing clinically targeted surveillance programs. Conclusion: For female patients who have undergone alloHSCT, targeted surveillance for early identification of VVGvHD results in earlier treatment initiation. Subsequently, this can improve sexual health, partner relationships, and quality of life in patients after stem cell transplant.
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Affiliation(s)
| | - Christi Bowe
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joyce E Dains
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Abstract
OBJECTIVE The aim of the study was to describe the clinical and histopathologic features required for a clinicopathologic diagnosis of vulvar lichen planus (LP), which is divided into 3 types: erosive, classic, and hypertrophic. MATERIALS AND METHODS The International Society of the Study of Vulvovaginal Diseases tasked the Difficult Pathologic Diagnoses committee with development of a consensus document for the clinicopathologic diagnosis of vulvar LP, lichen sclerosus, and differentiated vulvar intraepithelial neoplasia. The LP subgroup reviewed the literature and formulated diagnostic criteria, then approved by the International Society of the Study of Vulvovaginal Diseases membership. RESULTS The clinicopathologic diagnosis of erosive LP incorporates 5 criteria: (a) a well-demarcated, glazed red macule or patch at labia minora, vestibule, and/or vagina, (b) disease affects hairless skin, mucocutaneous junction, and/or nonkeratinized squamous epithelium, (c) evidence of basal layer damage, categorized as degenerative or regenerative, (d) a closely applied band-like lymphocytic infiltrate, and (e) absent subepithelial sclerosis. The clinicopathologic diagnoses of classic and hypertrophic LP each require a characteristic clinical appearance accompanied by hyperkeratosis, hypergranulosis, acanthosis, basal layer degeneration, a closely applied lymphocytic infiltrate, and absent dermal sclerosis, with hypertrophic LP showing marked epithelial abnormality compared with classic LP. CONCLUSIONS Clinicopathological correlation yields the most reliable diagnosis of vulvar LP. Disease appearance overlaps with other physiologic, dermatologic, infectious, and neoplastic entities; a low threshold for biopsy at all morphologically distinct areas is recommended. Use of the histopathologic criteria described in this document may reduce the nondiagnostic biopsy rate for clinically diagnosed LP.
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13
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Allen SM, Liang CS, Chesnokova AE, Childress KJ, Pascoe KF, Dietrich JE. Patterns of Genital Examination and Vulvovaginal Graft-Versus-Host Disease in a Pediatric Post-Hematopoietic Stem Cell Transplant Population. J Pediatr Adolesc Gynecol 2020; 33:658-666. [PMID: 32781233 DOI: 10.1016/j.jpag.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/29/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To determine vulvovaginal graft-versus-host disease (vvGVHD) incidence among pediatric patients who have received hematopoietic stem cell transplantation (HSCT) and who already have graft-versus-host disease (GVHD) involving any organ system and characterize patterns of genital examination and referral to pediatric and adolescent gynecology (PAG) in the post-HSCT population. DESIGN Retrospective chart review. SETTING Large tertiary children's hospital in Texas. PARTICIPANTS Eighty-six post-HSCT female patients 21 years old and younger with GVHD involving any organ system. INTERVENTIONS None. MAIN OUTCOME MEASURES vvGVHD among post-HSCT children, referrals to PAG, genital examinations documented by any clinician. RESULTS Eighty-six patients met inclusion criteria. Most HSCTs were bone marrow transplants, typically for leukemia. Median ages of indication diagnosis and HSCT were 5.1 and 7.5 years, respectively. Median time from HSCT to first GVHD diagnosis (eg, skin, intestine) was 96 days. Nearly all patients had at least 1 genital exam documented in the first 2 years post-HSCT, with a median of 17 exams. Twenty-eight patients were seen by PAG post-HSCT, with 7 of these patients seen within the first 2 years post-HSCT. Four symptomatic patients were diagnosed with vvGVHD. Median time from HSCT to vvGVHD was 398 days. CONCLUSION The small number of vvGVHD cases in our study population is likely because of lack of symptom reporting from patients and families and difficulty with vvGVHD diagnosis. Further training for non-PAG physicians, including pediatricians and oncologists, in identifying and managing vvGVHD might prevent delayed diagnosis and severe sequelae. Earlier referral to PAG or a gynecologist versed in post-HSCT survivorship is also recommended.
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Affiliation(s)
- Stephanie M Allen
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota.
| | - Cynthia S Liang
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Arina E Chesnokova
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Krista J Childress
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Kristin F Pascoe
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Departments of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, Texas; Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Texas
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Shalin SC, Racher LM, Campbell KK. Lichenoid dermatoses involving the vulva: A clinical-pathologic correlation ✰. Semin Diagn Pathol 2020; 38:3-18. [PMID: 32951943 DOI: 10.1053/j.semdp.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023]
Abstract
The lichenoid tissue reaction pattern generally signifies cytotoxic damage to the epithelium. When such reaction pattern occurs on vulvar skin or mucosa, the effects can result in considerable morbidity. None of the entities discussed in this review are entirely unique to the vulva, however, some entities may classically occur at this site, while others tend to be widespread diseases that may incidentally affect vulvar skin and mucosa. Given the complex anatomy of the vulva and the bridging of a site showing both keratinizing squamous epithelium and non-keratinizing squamous mucosa, histopathologic features may display variation in presentation. Although identification of a "lichenoid reaction pattern" alone may provide insight into the disease process, understanding of clinical presentation and specific sites of involvement, along with recognition of the nuanced features of the disease entities can help establish a specific diagnosis. Accurate histopathologic diagnoses by pathologists can improve the ability for treating clinicians to implement timely and effective treatment.
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Affiliation(s)
- Sara C Shalin
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Luann M Racher
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Katelynn K Campbell
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
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15
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Alsuliman T, Baylet C, Casabona A, Dann MP, De Bentzmann N, Fontoura ML, Genty C, Huynh A, Ibled D, Mercier L, Poirot C, Porcheron S, Tourette-Turgis C, Vernant JP, Vexiau-Robert D, Yakoub-Agha I, Nguyen S. [Sexual and emotional life after allogeneic hematopoietic stem cell transplant: Guidelines and patient booklet from the Francophone Society of Bone marrow Transplant and Cellular therapy (SFGM-TC)]. Bull Cancer 2020; 107:S151-S158. [PMID: 32747052 DOI: 10.1016/j.bulcan.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022]
Abstract
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organises annual workshops in an attempt to harmonise clinical practices among different francophone transplantation centres. The SFGM-TC harmonisation workshops aim at establishing practical guidelines, on the one hand, from data from the literature and international recommendations and, on the other hand, by consensus in the absence of formally proven data. The sexual and emotional life of allogeneic hematopoietic stem cells transplanted (HSCT) patients is often very impacted and remains a subject relatively little addressed by patients and caregivers. This article is an update from a previous workshop and is accompanied by a patient booklet, which will be included in the post allograft follow-up workbook published by the SFGM-TC. The purpose of these two documents is to facilitate discussions between patients and caregivers on the subject and to present proposals for follow-up and tools to better manage the sexual and emotional life of allotransplanted patients.
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Affiliation(s)
- Tamim Alsuliman
- Hôpital Saint-Antoine , AP-HP, Sorbonne université, service d'hématologie et thérapie cellulaire, 184, rue de Faubourg-Saint-Antoine, 75012 Paris, France.
| | - Caroline Baylet
- CHU d'Angers, service des maladies du sang, 4, rue Larrey, 49000 Angers, France.
| | - Audrey Casabona
- AP-HP Sorbonne, site Pitié-Salpêtrière, service d'hématologie clinique, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - Marie-Pierre Dann
- AP-HP Sorbonne, site Pitié-Salpêtrière, service d'hématologie clinique, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - Natacha De Bentzmann
- IUCT-Oncopole, service d'hématologie greffe, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
| | | | - Carole Genty
- CHRU de Dupuytren, service d'hématologie et de thérapie cellulaire, 2, avenue Martin Luther King, 87042 Limoges, France.
| | - Anne Huynh
- IUCT-Oncopole, service d'hématologie greffe, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
| | - Diane Ibled
- AP-HP Sorbonne, site Pitié-Salpêtrière, service d'hématologie clinique, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - Lara Mercier
- IUCT-Oncopole, service d'hématologie greffe, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
| | - Catherine Poirot
- Hôpital Saint-Louis, unité AJA, préservation de la fertilité, service d'hématologie, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Sophie Porcheron
- CLCC Henri-Becquerel, unité de soins intensifs hématologie, 1, rue d'Amiens, 76038 Rouen cedex, France.
| | | | - Jean-Paul Vernant
- AP-HP Sorbonne, site Pitié-Salpêtrière, service d'hématologie clinique, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | | | | | - Stéphanie Nguyen
- AP-HP Sorbonne, site Pitié-Salpêtrière, service d'hématologie clinique, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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16
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Klasa Ł, Sadowska-Klasa A, Piekarska A, Wydra D, Zaucha JM. The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation-a single-center real-life experience. Ann Hematol 2020; 99:1361-1368. [PMID: 32342133 PMCID: PMC7237515 DOI: 10.1007/s00277-020-04034-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/10/2020] [Indexed: 10/29/2022]
Abstract
In everyday gynecological practice, there is an unmet need to manage survivors after allogeneic hematopoietic cell transplantation (allo-HCT). The major gynecological complications include premature ovarian insufficiency (POI), chronic graft-versus-host disease (cGVHD) of the anogenital zone (cGVHDgyn), and secondary neoplasms. Aiming to assess a real-life scale of problems associated with HCT, we performed a detailed analysis of a consecutive series of females after allo-HCT who were referred for a routine gynecological evaluation. The study includes 38 females after allo-HCT in whom gynecological examination with cervical smear and USG were performed, followed by colposcopy according to NCCN guidelines. NIH scoring system was used to classify a grade of cGVHDgyn. The incidence of cGVHD was 71% whereas GVHDgyn was 29%, including 5 patients with score 3 at the time of diagnosis. The other manifestations (frequently noted) included the skin, mucosa, eyes, and liver. Menopause was diagnosed in 93% females, and in 81% of them, POI criteria were fulfilled. Ovarian function resumed in 2 cases. The rate of abnormal cytology was 26%: 4 ASCUS, 1 AGUS, 1 LSIL, 3 HSIL/ASC-H, and one cytological suspicion of cervical cancer. GVHDgyn was documented in 10 patients, and 6 of them had abnormal cervical cytology. Early topical estrogen therapy led to a significant reduction in vaginal dryness (p < 0.05), dyspareunia (p < 0.05), and less frequent cGVHDgyn (p < 0.05). GVHDgyn develops in about 30% of long-term allo-HCT survivors. Topical estrogens and hormonal replacement therapy alleviate symptoms and prevent the occurrence of severe consequences of menopause.
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Affiliation(s)
- Łukasz Klasa
- Department of Gynecology, Oncological Gynecology and Gynecological Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Alicja Sadowska-Klasa
- Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland.
| | - Agnieszka Piekarska
- Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Wydra
- Department of Gynecology, Oncological Gynecology and Gynecological Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
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17
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Abstract
Hematopoietic cell transplantation (HCT) is associated with well-described gynecologic sequelae, including vulvovaginal graft-versus-host disease (GVHD). Vulvovaginal GVHD is a common complication of allogeneic HCT, but has been under-reported in the literature. Guidelines have been published only recently to recommend common terminology, treatment, and surveillance. This review summarizes the presentation, management, and surveillance aspects of vulvovaginal GVHD. We recommend a standardized referral between women undergoing HCT and an experienced gynecologist capable of managing this disease and treating sexual side effects.
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Affiliation(s)
- M Jacobson
- Department of Obstetrics and Gynaecology, Women's College Hospital , Toronto , ON , Canada.,Department of Obstetrics and Gynaecology, Sinai Health System , Toronto , ON , Canada.,Department of Obstetrics and Gynaecology, University of Toronto , Toronto , ON , Canada
| | - J Wong
- Department of Obstetrics and Gynaecology, University of Toronto , Toronto , ON , Canada
| | - A Li
- Department of Obstetrics and Gynaecology, University of Toronto , Toronto , ON , Canada
| | - W L Wolfman
- Department of Obstetrics and Gynaecology, Sinai Health System , Toronto , ON , Canada.,Department of Obstetrics and Gynaecology, University of Toronto , Toronto , ON , Canada
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18
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ACOG Committee Opinion No. 747: Gynecologic Issues in Children and Adolescent Cancer Patients and Survivors. Obstet Gynecol 2018; 132:e67-e77. [DOI: 10.1097/aog.0000000000002763] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Machado AMN, Hamerschlak N, Rodrigues M, Piccinato CDA, Podgaec S, Mauad LMQ. Female genital tract chronic graft-versus-host disease: A narrative review. Hematol Transfus Cell Ther 2018; 41:69-75. [PMID: 30793107 PMCID: PMC6371232 DOI: 10.1016/j.htct.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/20/2018] [Indexed: 01/03/2023] Open
Abstract
Graft-versus-host disease is one of the main causes of morbidity and mortality in patients submitted to hematopoietic stem cell transplantation. This study reviewed the prevalence of lower female genital tract graft-versus-host disease following hematopoietic stem cell transplantation. A systematic search of the literature for articles published between 1982 and 2015 was performed. A growing number of young women suffering from malignant and benign hematological diseases are receiving allogeneic hematopoietic stem cell transplantation with very satisfactory results in relation to the disease itself. However, these patients face gynecological problems due to graft-versus-host disease. Correct diagnosis and early management are needed to avoid irreversible complications.
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Affiliation(s)
| | | | | | | | - Sergio Podgaec
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil
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20
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Rajkumar S, Lewis F, Nath R. The importance of topical steroids after adhesiolysis in erosive lichen planus and graft versus host disease. J OBSTET GYNAECOL 2018; 39:82-85. [DOI: 10.1080/01443615.2018.1463207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- S. Rajkumar
- Department of Gynaecological Oncology, Guy’s and St Thomas NHS Trust, London, UK
| | - F. Lewis
- St John’s Institute of Dermatology, Guy’s and St Thomas NHS Trust, London, UK
| | - R. Nath
- Department of Gynaecological Oncology, Guy’s and St Thomas NHS Trust, London, UK
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21
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Smith Knutsson E, Björk Y, Broman AK, Helström L, Nicklasson M, Brune M, Sundfeldt K. A prospective study of female genital chronic graft-versus-host disease symptoms, signs, diagnosis and treatment. Acta Obstet Gynecol Scand 2018; 97:1122-1129. [DOI: 10.1111/aogs.13366] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Eva Smith Knutsson
- Department of Obstetrics and Gynecology; NU Hospital Group; Trollhättan; and Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Yvonne Björk
- Section of Hematology and Coagulation; Department of Medicine; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Anna-Karin Broman
- Department of Obstetrics and Gynecology; NU Hospital Group; Trollhättan Sweden
| | - Lotti Helström
- Department of Clinical Science and Education; Karolinska Institute; Stockholm South General Hospital; Stockholm Sweden
| | - Malin Nicklasson
- Section of Hematology and Coagulation; Department of Medicine; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Mats Brune
- Section of Hematology and Coagulation; Department of Medicine; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Karin Sundfeldt
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
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22
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23
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Hamilton BK, Goje O, Savani BN, Majhail NS, Stratton P. Clinical management of genital chronic GvHD. Bone Marrow Transplant 2017; 52:803-810. [DOI: 10.1038/bmt.2016.315] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 01/12/2023]
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24
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Sexual function 1-year after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2016; 51:833-40. [PMID: 26878660 DOI: 10.1038/bmt.2015.342] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 11/23/2015] [Accepted: 12/08/2015] [Indexed: 01/12/2023]
Abstract
Treatment with allogeneic hematopoietic stem cell transplantation (HSCT) is associated with short and long-term toxicities that can result in alterations in sexual functioning. The aims of this prospective evaluation were to determine: (1) associations between HSCT and increased sexual dysfunction 1 year after treatment; and (2) associations between sexual dysfunction, body image, anxiety and depression. This controlled prospective cohort study was conducted from October 2010 to November 2013. Patients completed assessments 2-3 weeks before HSCT (N=124) and 1 year after treatment (N=63). Assessment included descriptive data, Sexual Functioning Questionnaire, Body Image Scale and Hospital Anxiety and Depression Scale. The results showed a significant decline in overall sexual function in both men and women (P=<0.001, P=0.010, respectively), although men generally scored higher than women. Forty-seven percent of men and 60% of women reported at least one physical sexual problem 1 year after HSCT. Patients with chronic GVHD trended toward reporting lower levels of sexual function. Finally, women with chronic GVHD scored lower than those without chronic GVHD on the sexual function problem subscale (P=0.008). Sexual dysfunction remains a major problem for men and women 1 year after HSCT and requires routine evaluation and treatment after HSCT.
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25
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Chung CP, Sargent RE, Chung NT, Lacey JV, Wakabayashi MT. Graft-versus-Host Disease–Associated Vulvovaginal Symptoms after Bone Marrow Transplantation. Biol Blood Marrow Transplant 2016; 22:378-379. [DOI: 10.1016/j.bbmt.2015.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
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26
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Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, Palmer J, Weisdorf D, Treister NS, Cheng GS, Kerr H, Stratton P, Duarte RF, McDonald GB, Inamoto Y, Vigorito A, Arai S, Datiles MB, Jacobsohn D, Heller T, Kitko CL, Mitchell SA, Martin PJ, Shulman H, Wu RS, Cutler CS, Vogelsang GB, Lee SJ, Pavletic SZ, Flowers MED. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant 2015; 21:389-401.e1. [PMID: 25529383 PMCID: PMC4329079 DOI: 10.1016/j.bbmt.2014.12.001] [Citation(s) in RCA: 1725] [Impact Index Per Article: 191.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 12/01/2014] [Indexed: 12/13/2022]
Abstract
The 2005 National Institutes of Health (NIH) Consensus Conference proposed new criteria for diagnosing and scoring the severity of chronic graft-versus-host disease (GVHD). The 2014 NIH consensus maintains the framework of the prior consensus with further refinement based on new evidence. Revisions have been made to address areas of controversy or confusion, such as the overlap chronic GVHD subcategory and the distinction between active disease and past tissue damage. Diagnostic criteria for involvement of mouth, eyes, genitalia, and lungs have been revised. Categories of chronic GVHD should be defined in ways that indicate prognosis, guide treatment, and define eligibility for clinical trials. Revisions have been made to focus attention on the causes of organ-specific abnormalities. Attribution of organ-specific abnormalities to chronic GVHD has been addressed. This paradigm shift provides greater specificity and more accurately measures the global burden of disease attributed to GVHD, and it will facilitate biomarker association studies.
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Affiliation(s)
- Madan H Jagasia
- Department of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hildegard T Greinix
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Mukta Arora
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kirsten M Williams
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Department of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Daniel Wolff
- Department of Internal Medicine, University of Regensburg, Regensburg, Germany
| | - Edward W Cowen
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeanne Palmer
- Department of Hematology Oncology/Blood and Marrow Transplant, Mayo Clinic Arizona, Phoenix, Arizona
| | - Daniel Weisdorf
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Nathaniel S Treister
- Department of Surgery, Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Guang-Shing Cheng
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Holly Kerr
- Hematology Department, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Pamela Stratton
- Pediatric and Reproductive Endocrinology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Rafael F Duarte
- Department of Hematology, Institut Catala d'Oncologia, Barcelona, Spain
| | - George B McDonald
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Afonso Vigorito
- Hematology and Hemotherapy Center, Hemocentro Unicamp, Campinas, Sao Paulo, Brazil
| | - Sally Arai
- Department of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Manuel B Datiles
- The Eye Clinic, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - David Jacobsohn
- Department of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland
| | - Carrie L Kitko
- Blood and Marrow Transplant Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Sandra A Mitchell
- Department of Applied Research Cancer Control and Population Sciences, National Institutes of Health, Bethesda, Maryland
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Howard Shulman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Roy S Wu
- Cancer Therapy Evaluation Program, National Institutes of Health, Bethesda, Maryland
| | - Corey S Cutler
- Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Georgia B Vogelsang
- Oncology Department, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Steven Z Pavletic
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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27
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Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, Palmer J, Weisdorf D, Treister NS, Cheng GS, Kerr H, Stratton P, Duarte RF, McDonald GB, Inamoto Y, Vigorito A, Arai S, Datiles MB, Jacobsohn D, Heller T, Kitko CL, Mitchell SA, Martin PJ, Shulman H, Wu RS, Cutler CS, Vogelsang GB, Lee SJ, Pavletic SZ, Flowers MED. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION : JOURNAL OF THE AMERICAN SOCIETY FOR BLOOD AND MARROW TRANSPLANTATION 2014. [PMID: 25529383 DOI: 10.1016/j.bbmt.2014.12.001.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The 2005 National Institutes of Health (NIH) Consensus Conference proposed new criteria for diagnosing and scoring the severity of chronic graft-versus-host disease (GVHD). The 2014 NIH consensus maintains the framework of the prior consensus with further refinement based on new evidence. Revisions have been made to address areas of controversy or confusion, such as the overlap chronic GVHD subcategory and the distinction between active disease and past tissue damage. Diagnostic criteria for involvement of mouth, eyes, genitalia, and lungs have been revised. Categories of chronic GVHD should be defined in ways that indicate prognosis, guide treatment, and define eligibility for clinical trials. Revisions have been made to focus attention on the causes of organ-specific abnormalities. Attribution of organ-specific abnormalities to chronic GVHD has been addressed. This paradigm shift provides greater specificity and more accurately measures the global burden of disease attributed to GVHD, and it will facilitate biomarker association studies.
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Affiliation(s)
- Madan H Jagasia
- Department of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hildegard T Greinix
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Mukta Arora
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kirsten M Williams
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Department of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Daniel Wolff
- Department of Internal Medicine, University of Regensburg, Regensburg, Germany
| | - Edward W Cowen
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeanne Palmer
- Department of Hematology Oncology/Blood and Marrow Transplant, Mayo Clinic Arizona, Phoenix, Arizona
| | - Daniel Weisdorf
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Nathaniel S Treister
- Department of Surgery, Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Guang-Shing Cheng
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Holly Kerr
- Hematology Department, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Pamela Stratton
- Pediatric and Reproductive Endocrinology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Rafael F Duarte
- Department of Hematology, Institut Catala d'Oncologia, Barcelona, Spain
| | - George B McDonald
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Afonso Vigorito
- Hematology and Hemotherapy Center, Hemocentro Unicamp, Campinas, Sao Paulo, Brazil
| | - Sally Arai
- Department of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Manuel B Datiles
- The Eye Clinic, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - David Jacobsohn
- Department of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland
| | - Carrie L Kitko
- Blood and Marrow Transplant Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Sandra A Mitchell
- Department of Applied Research Cancer Control and Population Sciences, National Institutes of Health, Bethesda, Maryland
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Howard Shulman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Roy S Wu
- Cancer Therapy Evaluation Program, National Institutes of Health, Bethesda, Maryland
| | - Corey S Cutler
- Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Georgia B Vogelsang
- Oncology Department, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Steven Z Pavletic
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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