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The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life experience
In everyday gynecological practice, there is an unmet need to manage survivors after allogeneic hematopoietic cell transplantation (allo-HCT). The major gynecological complications include premature ovarian insufficiency (POI), chronic graft-versus-host disease (cGVHD) of the anogenital zone (cGVHDg...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237515/ https://www.ncbi.nlm.nih.gov/pubmed/32342133 http://dx.doi.org/10.1007/s00277-020-04034-1 |
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author | Klasa, Łukasz Sadowska-Klasa, Alicja Piekarska, Agnieszka Wydra, Dariusz Zaucha, Jan Maciej |
author_facet | Klasa, Łukasz Sadowska-Klasa, Alicja Piekarska, Agnieszka Wydra, Dariusz Zaucha, Jan Maciej |
author_sort | Klasa, Łukasz |
collection | PubMed |
description | In everyday gynecological practice, there is an unmet need to manage survivors after allogeneic hematopoietic cell transplantation (allo-HCT). The major gynecological complications include premature ovarian insufficiency (POI), chronic graft-versus-host disease (cGVHD) of the anogenital zone (cGVHDgyn), and secondary neoplasms. Aiming to assess a real-life scale of problems associated with HCT, we performed a detailed analysis of a consecutive series of females after allo-HCT who were referred for a routine gynecological evaluation. The study includes 38 females after allo-HCT in whom gynecological examination with cervical smear and USG were performed, followed by colposcopy according to NCCN guidelines. NIH scoring system was used to classify a grade of cGVHDgyn. The incidence of cGVHD was 71% whereas GVHDgyn was 29%, including 5 patients with score 3 at the time of diagnosis. The other manifestations (frequently noted) included the skin, mucosa, eyes, and liver. Menopause was diagnosed in 93% females, and in 81% of them, POI criteria were fulfilled. Ovarian function resumed in 2 cases. The rate of abnormal cytology was 26%: 4 ASCUS, 1 AGUS, 1 LSIL, 3 HSIL/ASC-H, and one cytological suspicion of cervical cancer. GVHDgyn was documented in 10 patients, and 6 of them had abnormal cervical cytology. Early topical estrogen therapy led to a significant reduction in vaginal dryness (p < 0.05), dyspareunia (p < 0.05), and less frequent cGVHDgyn (p < 0.05). GVHDgyn develops in about 30% of long-term allo-HCT survivors. Topical estrogens and hormonal replacement therapy alleviate symptoms and prevent the occurrence of severe consequences of menopause. |
format | Online Article Text |
id | pubmed-7237515 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-72375152020-05-27 The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life experience Klasa, Łukasz Sadowska-Klasa, Alicja Piekarska, Agnieszka Wydra, Dariusz Zaucha, Jan Maciej Ann Hematol Original Article In everyday gynecological practice, there is an unmet need to manage survivors after allogeneic hematopoietic cell transplantation (allo-HCT). The major gynecological complications include premature ovarian insufficiency (POI), chronic graft-versus-host disease (cGVHD) of the anogenital zone (cGVHDgyn), and secondary neoplasms. Aiming to assess a real-life scale of problems associated with HCT, we performed a detailed analysis of a consecutive series of females after allo-HCT who were referred for a routine gynecological evaluation. The study includes 38 females after allo-HCT in whom gynecological examination with cervical smear and USG were performed, followed by colposcopy according to NCCN guidelines. NIH scoring system was used to classify a grade of cGVHDgyn. The incidence of cGVHD was 71% whereas GVHDgyn was 29%, including 5 patients with score 3 at the time of diagnosis. The other manifestations (frequently noted) included the skin, mucosa, eyes, and liver. Menopause was diagnosed in 93% females, and in 81% of them, POI criteria were fulfilled. Ovarian function resumed in 2 cases. The rate of abnormal cytology was 26%: 4 ASCUS, 1 AGUS, 1 LSIL, 3 HSIL/ASC-H, and one cytological suspicion of cervical cancer. GVHDgyn was documented in 10 patients, and 6 of them had abnormal cervical cytology. Early topical estrogen therapy led to a significant reduction in vaginal dryness (p < 0.05), dyspareunia (p < 0.05), and less frequent cGVHDgyn (p < 0.05). GVHDgyn develops in about 30% of long-term allo-HCT survivors. Topical estrogens and hormonal replacement therapy alleviate symptoms and prevent the occurrence of severe consequences of menopause. Springer Berlin Heidelberg 2020-04-28 2020 /pmc/articles/PMC7237515/ /pubmed/32342133 http://dx.doi.org/10.1007/s00277-020-04034-1 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Article Klasa, Łukasz Sadowska-Klasa, Alicja Piekarska, Agnieszka Wydra, Dariusz Zaucha, Jan Maciej The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life experience |
title | The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life experience |
title_full | The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life experience |
title_fullStr | The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life experience |
title_full_unstemmed | The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life experience |
title_short | The management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life experience |
title_sort | management of gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation—a single-center real-life experience |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237515/ https://www.ncbi.nlm.nih.gov/pubmed/32342133 http://dx.doi.org/10.1007/s00277-020-04034-1 |
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