To determine vulvovaginal (vv) GVHD incidence among pediatric patients who are post-hematopoietic stem cell transplant (HSCT) and who already have 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: 86 post-HSCT female patients ≤21 years old 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: 86 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 (e.g. 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. 28 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.
The small number of vvGVHD cases in our study population is likely due to 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 may prevent delayed diagnosis and severe sequelae. Earlier referral to PAG or a gynecologist versed in post-HSCT survivorship is also recommended.

Copyright © 2020. Published by Elsevier Inc.

References

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