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.

中文翻译：

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小儿造血干细胞移植人群中生殖器官检查和外阴嫁接对宿主疾病的模式。

研究目的

确定在造血后干细胞移植（HSCT）且已患有涉及任何器官系统的GVHD的儿科患者中外阴（vv）GVHD的发生率，并表征生殖器检查的模式以及在转诊后转诊至儿科和青少年妇科（PAG） -HSCT人口

设计

回顾性图表审查

设置

德克萨斯州的大型三级儿童医院

参加者

86例21岁以下的HSCT后女性患者，GVHD涉及任何器官系统

干预措施

没有

主要观察指标

HSCT后儿童中的vvGVHD，转介到PAG，任何临床医生记录的生殖器检查

结果

86名患者符合入选标准。大多数HSCT是骨髓移植，通常用于白血病。适应症诊断和HSCT的中位年龄分别为5.1岁和7.5岁。从HSCT到首次GVHD诊断（例如皮肤，肠道）的中位时间为96天。几乎所有患者在HSCT后的头2年中至少记录了1次生殖器检查，中位检查为17次。HSCT后，PAG观察到28例患者，其中7例在HSCT后的前两年内观察到。四名有症状的患者被诊断患有vvGVHD。从HSCT到vvGVHD的平均时间为398天。

结论

在我们的研究人群中，少数vvGVHD病例可能是由于缺乏患者和家庭的症状报告以及vvGVHD诊断困难。对非PAG医师（包括儿科医生和肿瘤学家）进行进一步的培训，以鉴定和管理vvGVHD可能会预防诊断延迟和严重后遗症。还建议您更早转诊PAG或精通HSCT后生存的妇科医生。