Study Objective

To assess genital symptomatology, characterize the findings of genital examination, and describe the incidence and treatment of vulvovaginal graft-versus-host disease (vvGvHD) in girls and adolescents after allogeneic hematopoietic stem cell transplantation (HSCT).

Design

Retrospective cohort.

Setting

Metropolitan-area children's hospital.

Participants

Female allogeneic HSCT recipients ages 0 to 22 years.

Main Outcome Measures

Genital symptoms, genital examination, diagnosis, and treatment of vvGvHD.

Results

A total of 57 participants were included in the analysis. The median age at the time of HSCT was 10 years (range 4 months−23 years). Most (n = 40, 71%) underwent transplant for a nonmalignant condition, most commonly sickle cell anemia (n = 19, 33%). The median time of onset of GvHD post HSCT was 62 days (IQR = 42 to 151 days). The most common initial site of GvHD was skin (n = 21, 64%), followed by GI tract (n = 10, 30%). Three patients (5%) were diagnosed with vvGvHD. The time of onset of vvGvHD post HSCT ranged from 62 to 1565 days. One patient (33%) was asymptomatic at the time of diagnosis. There was no difference in diagnosis of vvGvHD when race (P = 0.15), age at allogeneic HSCT (P = 0.64), nonmalignant vs malignant indication (P = 0.21), source of stem cells (P = 0.25), partial vs full human leukocyte antigens (HLA) donor match (P = 0.34), and GvHD prophylaxis regimen (P = 0.18) were compared. None had isolated vvGvHD. Vulvovaginal GvHD was preceded by skin GvHD in 1 patient, was preceded by lung GvHD in 1 patient, and occurred concurrently with skin GvHD in the third patient.

Conclusions

Pediatric vvGvHD can occur within the first 100 days after transplant and can be asymptomatic. Routine gynecologic evaluation post allogeneic HSCT in children and adolescents should include a thorough review of vulvovaginal symptoms and a gynecologic exam for the detection and treatment of vvGvHD.

中文翻译：

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儿科外阴阴道移植物抗宿主病：回顾性队列研究和文献综述

学习目的

评估生殖器症状，描述生殖器检查结果的特征，并描述女孩和青少年异基因造血干细胞移植（HSCT）后外阴阴道移植物抗宿主病（vvGvHD）的发病率和治疗。

设计

回顾性队列。

环境

首都圈儿童医院。

参加者

年龄 0 至 22 岁的女性同种异体 HSCT 接受者。

主要观察指标

vvGvHD 的生殖器症状、生殖器检查、诊断和治疗。

结果

共有 57 名参与者参与了分析。HSCT 时的中位年龄为 10 岁（范围 4 个月−23 岁）。大多数 ( n  = 40, 71%) 因非恶性疾病接受移植，最常见的是镰状细胞性贫血 ( n  = 19, 33%)。HSCT 后发生 GvHD 的中位时间为 62 天（IQR = 42 至 151 天）。GvHD 最常见的初始部位是皮肤（n  = 21， 64%），其次是胃肠道（n  = 10， 30%）。三名患者 (5%) 被诊断患有 vvGvHD。HSCT 后 vvGvHD 的发病时间范围为 62 至 1565 天。一名患者（33%）在诊断时没有症状。在种族 ( P  = 0.15)、同种异体 HSCT 年龄 ( P  = 0.64)、非恶性与恶性适应症 ( P = 0.21)、干细胞来源 ( P  = 0.25)、部分与完整人类 干细胞来源方面，vvGvHD 的诊断没有差异 比较白细胞抗原 (HLA) 供体匹配 ( P  = 0.34) 和 GvHD 预防方案 ( P = 0.18)。没有人患有孤立性 vvGvHD。1 名患者中外阴阴道 GvHD 先于皮肤 GvHD，1 名患者中先于肺 GvHD，第 3 名患者中与皮肤 GvHD 同时发生。

结论

儿童 vvGvHD 可能发生在移植后的前 100 天内，并且可能无症状。儿童和青少年异基因 HSCT 后的常规妇科评估应包括彻底检查外阴阴道症状和妇科检查，以发现和治疗 vvGvHD。