Gynaecological complications and vulvovaginal graft-versus-host disease after allogeneic haematopoietic stem cell transplantation: a retrospective study.
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Hematopoietic stem cell transplantation (HSCT), a key treatment for haematological malignancies and other bone marrow disorders, may lead to complications such as vulvovaginal GvHD, an under-recognised and frequently under-diagnosed condition. We conducted an observational, retrospective, single-centre study at the Centre Henri Becquerel in Rouen, including all women who underwent allogeneic HSCT since 2017 and had at least one gynaecological consultation; data were collected between April 2023 and April 2024. Among the 110 patients analysed, vulvovaginal GvHD was identified in 25.5%, most often with late onset and severe forms. Treatment, mainly topical with systemic therapy in more severe cases, led to clinical improvement or resolution in 65.4% of cases. Other post-transplant gynaecological complications were also assessed: rates of HPV positivity and cervical cytological abnormalities were not significantly increased after transplantation; menometrorrhagia was observed in 6.5% of patients; and premature ovarian insufficiency occurred in 53.3% of women under 40 years. Sexual dysfunction was markedly more frequent in women with vulvovaginal GvHD, particularly vaginal dryness (57.1% vs. 28.8%; p = 0.014) and dyspareunia (73.9% vs. 26.2%; p < 0.001). These findings highlight that vulvovaginal GvHD and other gynaecological sequelae remain under-estimated, underscoring the need for systematic and individualised gynaecological follow-up after allogeneic HSCT.