19 - Gynecological Manifestations of Chronic Graft versus Host Disease

Summary

INTRODUCTION

Chronic graft versus host disease (cGVHD) is a multisystem disorder that occurs in 60% to 70% of long-term survivors of allogeneic hematopoietic stem cell transplantation (HSCT) and has been increasing in incidence because of improved survival of posttransplant recipients. The longer survival and unrelenting progression of cGVHD affect several aspects of health and may result in loss of organ function and impaired quality of life.

Under the leadership of the National Institutes of Health, a multidisciplinary group of investigators studying cGVHD established a consortium to study, assemble, and broadcast information about this disease and its treatment as well as to influence the direction of new research into its pathogenic mechanisms. The group has since published several papers relating to the diagnosis and staging histology, and ancillary care of patients with cGVHD. In these consensus reports, the gynecologic aspects of this disease are barely mentioned.

The report on ancillary care recommends that as most transplant physicians are not in a position to address gynecologic problems, women with complaints of vulvar irritation should be referred to their gynecologists. Unfortunately, most gynecologists know very little about stem cell transplant recipients and cGVHD. It is with the hope of furthering knowledge regarding this heretofore neglected aspect of cGVHD that we contribute our experiences at the National Institutes of Health derived from evaluating and caring for the gynecologic problems of women with cGVHD.