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- Title
The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation-a single-center real-life experience.
- Authors
Klasa, Łukasz; Sadowska-Klasa, Alicja; Piekarska, Agnieszka; Wydra, Dariusz; Zaucha, Jan Maciej
- 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.
- Subjects
NATIONAL Institutes of Health (U.S.); CELL transplantation; PREMATURE ovarian failure; ESTROGEN replacement therapy; COLPOSCOPY; GRAFT versus host disease; GYNECOLOGIC care; GENITOURINARY diseases; VAGINAL dryness; FEMALE reproductive organ diseases; HOMOGRAFTS; HEMATOPOIETIC stem cell transplantation; DISEASE management; LONGITUDINAL method
- Publication
Annals of Hematology, 2020, Vol 99, Issue 6, p1361
- ISSN
0939-5555
- Publication type
journal article
- DOI
10.1007/s00277-020-04034-1