Abstract

Evaluation of Female Chronic Genital GVHD after Hematopoietic Stem Cell Transplantation in Patients Referring to Shariati Hospital of Tehran: A Cross Sectional Study

Introduction: Chronic genital Graft Versus Host Disease (GVHD) is a complication of Bone Marrow Transplantation (BMT) that is often ignored in patients while it may be the only manifestation of chronic GVHD and may lead to severely impaired sexual function of patient after transplantation. Women's examination is not routine in post-transplant visits in Iran. This study aimed to investigate the genital conditions of patients undergoing bone marrow transplantation.

Methods and Materials: Female patients (aged 20 years-60 years) who had undergone BMT in Shariati Hospital were enrolled in this evaluation. Participants were interviewed for symptoms of chronic genital GVHD during three visits with a 6-8 weeks interval. Physical examinations including vaginal observation, digital exam and speculum insertion were also performed by a gynecologist and signs were recorded. In the second visit, if lesions were observed, a biopsy was conducted and otherwise a blind biopsy was performed from the vaginal mucosa or posterior fourchette under local anesthesia. Frequency of symptoms and signs of chronic genital GVHD, relation between symptoms/signs and pathologic findings was assessed. Data were analyzed with Stata software version 12.

Findings: Of 79 enrolled patients, the most prevalent diseases that resulted in transplantation were AML and ALL with 45 (57%) and 16 (20.3%) patients respectively. Median age was 35 years and median follow up time was 28 ± 3.14 months. The median time from transplant to 2^nd visit was 29.2 ± 2.07 Months. Sixty-nine patients had acute GVHD after transplantation. 65 (82.3%) patients had Amenorrhea after transplant. Chronic genital GVHD score based on NIH scoring system was significantly correlated with non-genital chronic GVHD, but not with acute GVHD. Pathologic findings were not significantly correlated with any clinical signs and symptoms of chronic GVHD (P>0.05). At the end of study 69 patients were alive and 65 (81.8%) were in remission. One-year and two years survival was 87.09 ± 3.82 and 82.81 ± 5.20 respectively.

Conclusion: Our evaluation of the prevalence, clinical signs and symptoms of chronic genital GVHD in a crosssectional study using NIH criteria showed that in most cases the diagnosis was missed and while findings of genital biopsy were non-specific and were not consistent with clinical signs and symptoms. It may be necessary to use a regular follow-up program with post-transplantation gynecologic examinations to ensure prompt diagnosis of this complication. On the other hand, the administration topical medications in early stages is much better than the next stages and resulted in improved quality of sexual life of patients which most were in reproductive age and has less costs than management of disease complications.

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