Patterns of Genital Examination and Vulvovaginal Graft-Versus-Host Disease in a Pediatric Post-Hematopoietic Stem Cell Transplant Population - 04/12/20
, Cynthia S. Liang, BS 1, Arina E. Chesnokova, MD, MPH 1, 3, Krista J. Childress, MD 1, 4, Kristin F. Pascoe, MD 1, 5, Jennifer E. Dietrich, MD, MSc 1, 6Abstract |
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.
Le texte complet de cet article est disponible en PDF.Key Words : Graft-versus-host disease, Hematopoietic stem cell transplantation, Vulvar diseases, Cancer survivors, Transplant recipients
Plan
| The authors indicate no conflicts of interest. |
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| Aspects of this work have been previously presented as posters at the North American Society for Pediatric and Adolescent Gynecology Annual Clinical and Research Meeting: April 20-22, 2017 in Chicago, Illinois, and April 11-13, 2019 in New Orleans, Louisiana. |
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| Abstracts of the posters presented were published in the Journal of Pediatric and Adolescent Gynecology as follows: Chesnokova AE, Childress KJ, Dietrich JE: Gynecologic care and evaluation of vulvovaginal graft versus host disease after stem cell transplant in the pediatric and adolescent population: an initial assessment. J Pediatr Adolesc Gynecol 2017; 30:2 (j.jpag.2017.03.044). Liang CS, Allen SM, Pascoe KF, et al: Prevalence and surveillance of vulvovaginal graft versus host disease after hematopoietic stem cell transplant in the pediatric population: an analysis of 84 patients. J Pediatr Adolesc Gynecol 2019; 32:2 (j.jpag.2019.02.096). |
Vol 33 - N° 6
P. 658-666 - décembre 2020 Retour au numéro
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