Female Genital Chronic Graft-Versus-Host Disease: Importance of Early Diagnosis to Avoid Severe Complications
Female Genital Chronic Graft-Versus-Host Disease: Importance of Early Diagnosis to Avoid Severe Complications
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DOI：
10.1097/tp.0b013e31824f3dcd
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发表时间：
2012-06-27
期刊：
影响因子：
6.2
通讯作者：
Vexiau-Robert, Dominique
中科院分区：
文献类型：
--
作者：
Hirsch, Pierre;Leclerc, Mathieu;Vexiau-Robert, Dominique
背景生殖器慢性移植物抗宿主病（GVHD）是异基因造血干细胞移植后常见但诊断不足的并发症，严重影响患者的生活质量。我们确定了32例生殖器慢性GVHD（cGVHD）女性患者，她们在2000年至2010年期间在我们中心接受了异基因造血干细胞移植，并在移植后接受了专门的妇科咨询。收集移植前和移植后的临床数据以及详细的急性和cGVHD数据。所有患者均接受相同的生殖器病变局部治疗。就诊时，大多数患者主诉阴道干燥和性交困难伴性活动障碍。50%的患者有I级生殖器病变，50%有II级或III级病变。在妇科会诊中晚期就诊的患者比移植后早期就诊的患者有更严重的病变。在诊断时，大多数患者具有cGVHD的其他皮肤或粘膜定位。在大多数情况下，病变稳定或减少局部类固醇和雌激素治疗，大多数患者可以恢复性活动。轻度病变患者的治疗效果优于其他患者。在接受过异基因造血干细胞移植的女性中，应在早期专业咨询中系统地搜索生殖器cGVHD，特别是在cGVHD的其他皮肤或粘膜定位的情况下。局部治疗联合类固醇和雌激素似乎可以防止I级生殖器病变的进一步发展，并避免手术治疗。
Background. Genital chronic graft-versus-host disease (GVHD) is a frequent but underdiagnosed complication of allogeneic stem-cell transplantation impairing quality of life.Methods. We identified 32 female patients with genital chronic GVHD (cGVHD) who underwent allogeneic hematopoietic stem-cell transplantation in our center between 2000 and 2010 and who were followed after transplantation in a specialized gynecological consultation. Pre- and posttransplantation clinical data and detailed acute and cGVHD data were collected. All patients received the same local treatment for genital lesions.Results. At presentation, most patients complained about vaginal dryness and dyspareunia with impairment in sexual activity. Fifty percent of patients had grade I genital lesions and 50% had grade II or III lesions. Patients seen later in gynecological consultation had more severe lesions than patients seen early after transplantation. At the time of diagnosis, most patients had other cutaneous or mucous localizations of cGVHD. In most cases, lesions were stabilized or decreased with local steroids and estrogen treatment, and most patients could resume sexual activity. Treatment was more efficient in patients with mild lesions than in others.Conclusions. Genital cGVHD should be systematically searched for in women who have received allogeneic hematopoietic stem-cell transplantation in an early specialized consultation, especially in case of other cutaneous or mucous localizations of cGVHD. Local treatment associating steroids and estrogen seemed to prevent further evolution of grade I genital lesions and to avoid surgical treatment.