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Vol 84, No 9 (2013)
ARTICLES
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Gynecological aspects of allogenic stem cell transplantation – incidence, risk factors and preventive strategies – description of two clinical cases and literature review

Tomasz Rechberger, Izabela Winkler, Katarzyna Preżyło, Beata Kulik-Rechberger
DOI: 10.17772/gp/1644
·
Ginekol Pol 2013;84(9).

open access

Vol 84, No 9 (2013)
ARTICLES

Abstract

Vaginal graft-versus-host disease (GVHD) is a rather common and underreported complication of allergenic stem cell transplantation. It occurs in approximately 25% of all women undergoing hematopoietic stem cell transplantation. In severe manifestation, GVHD might cause complete obliteration of the vagina which requires surgical intervention. In this paper we described 2 cases with complete obliteration of the vagina. We present a case report of 2 women (both 38 years old) diagnosed with complete vaginal obliteration after myeloablative chemotherapy and bone marrow transplant. Both patients were operated at the Second Department of Gynecology, Lublin. During the operation we reconstructed the entire vaginal length using either sharp or blunt dissection until the cervix was visualized. Immediately after the reconstruction, we placed a phantom within the vaginal canal for 7 days in order to separate the vaginal wall and prevent the formation of new adhesions. Both patients received antibiotic prophylaxis for 5 days, as well as ointment with Cyclosporine twice a day since postoperative day 2, and 50μg estrogen transdermal patch every 4 days. The patients were discharged from the hospital on postoperative day 7 and were recommended to use cyclosporine ointment twice a day and intra-vaginal tablets with Estrogen every 3 days. After 6 weeks a follow up revealed complete healing of the vaginal canal and both patients resumed uneventful sexual intercourses. A literature review of preventive strategies for vaginal GVHD was also presented.

Abstract

Vaginal graft-versus-host disease (GVHD) is a rather common and underreported complication of allergenic stem cell transplantation. It occurs in approximately 25% of all women undergoing hematopoietic stem cell transplantation. In severe manifestation, GVHD might cause complete obliteration of the vagina which requires surgical intervention. In this paper we described 2 cases with complete obliteration of the vagina. We present a case report of 2 women (both 38 years old) diagnosed with complete vaginal obliteration after myeloablative chemotherapy and bone marrow transplant. Both patients were operated at the Second Department of Gynecology, Lublin. During the operation we reconstructed the entire vaginal length using either sharp or blunt dissection until the cervix was visualized. Immediately after the reconstruction, we placed a phantom within the vaginal canal for 7 days in order to separate the vaginal wall and prevent the formation of new adhesions. Both patients received antibiotic prophylaxis for 5 days, as well as ointment with Cyclosporine twice a day since postoperative day 2, and 50μg estrogen transdermal patch every 4 days. The patients were discharged from the hospital on postoperative day 7 and were recommended to use cyclosporine ointment twice a day and intra-vaginal tablets with Estrogen every 3 days. After 6 weeks a follow up revealed complete healing of the vaginal canal and both patients resumed uneventful sexual intercourses. A literature review of preventive strategies for vaginal GVHD was also presented.
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Keywords

hematopoietic stem cell transplantation, myeloablative therapy, graft-versus-host disease, gynecological complications

About this article
Title

Gynecological aspects of allogenic stem cell transplantation – incidence, risk factors and preventive strategies – description of two clinical cases and literature review

Journal

Ginekologia Polska

Issue

Vol 84, No 9 (2013)

DOI

10.17772/gp/1644

Bibliographic record

Ginekol Pol 2013;84(9).

Keywords

hematopoietic stem cell transplantation
myeloablative therapy
graft-versus-host disease
gynecological complications

Authors

Tomasz Rechberger
Izabela Winkler
Katarzyna Preżyło
Beata Kulik-Rechberger

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