Female genital tract graft-versus-host disease following allogeneic bone marrow transplantation

Background and Objectives. Graft-versus-host disease (GVHD) is a complex syndrome observed after bone marrow transplantation (BMT) affecting several organs including the lower genital female tract. We tried to evaluate the incidence of genital tract involvement and whether there are specific risk factors. Design and Methods. A retrospective study was conducted in order to describe genital manifestations of GVHD and evaluate its incidence, severity and remission among 213 females who underwent BMT. The risk factors studied were previous pregnancies, vaginal cultures just before BMT and hormonal replacement therapy (HRT). Results. Genital lesions considered as expression of GVHD were found in 53 patients (24.9%). They appeared in the first 100 days after BMT in 12 women and beyond in 41 cases. Seventy-three percent of patients with such lesions showed some evidence of chronic GVHD elsewhere. The proposed grading, the first attempt of its kind, showed that genital chronic GVHD was minimal in 66%, moderate in 22% and severe in 12% of patients. Vaginal fibrosis, sometimes with complete obstruction, was seen in this last form. This occurred in 86.8% of patients after 2-157 months (median 22) while persistent GVHD was observed in 7 of them. In our sample no significant association was found between genital GVHD and previous pregnancies or vaginal infections at BMT, while HRT seems poorly associated with gynecological manifestations of GVHD (p=0.049). Interpretation and Conclusions. Genital GVHD is not unusual after BMT. It can seriously affect female sexuality and the overall quality of life. We suggest stressing the importance of early detection of genital involvement in order to prevent the most serious lesions. Further studies are needed to identify the triggering factors associated with the development of genital GVHD.