nutch_noindex
CANCEL
COVID-2019 Alert

Information about the 2019 Novel Coronavirus. Read the latest >

/nutch_noindex

Stephanie Cizek, MD

  • Stephanie Marie Cizek
Treats patients 12-26

Specialties

Pediatrics

Obstetrics & Gynecology

Work and Education

Professional Education

Case Western Reserve School of Medicine, Cleveland, OH, 05/19/2013

Residency

Kaiser Permanente Oakland Obstetrics and Gynecology Residency, Oakland, CA, 6/23/2017

Fellowship

Cincinnati Children's Hospital Pediatric and Adolescent Gynecology Fellowship, Cincinnati, OH, 07/03/2019

Board Certifications

Obstetrics & Gynecology, American Board of Obstetrics and Gynecology

All Publications

Pediatric and Young Adult Vulvovaginal Graft-versus-Host Disease BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Cizek, S. M., El-Bietar, J., Rubinstein, J., Dandoy, C., Wallace, G. H., Nelson, A., Khandelwal, P., Myers, K. C., Hoefgen, H. R. 2019; 25 (12): 240815

Abstract

Vulvovaginal graft-versus-host disease (GVHD) is an underdiagnosed and poorly recognized complication of hematopoietic stem cell transplantation (HSCT). Previous studies have reported findings restricted to predominantly adult populations. We report a case series of pediatric and young adult vulvovaginal GVHD, which was identified in 19 patients (median age, 11.8 years; range, 2.4 to 21.9 years) out of a total 302 female patients who underwent transplantation over an 8-year period at a pediatric HSCT center. The majority of patients had concomitant nongenital GVHD; only 1 patient had isolated vulvovaginal GVHD. The median time from bone marrow transplantation to diagnosis of vulvovaginal GVHD was 30 months (range, 2.3 to 97.5 months). A high percentage of the patients in our series were without vulvar or vaginal symptoms (n = 8; 42%), even though 17 patients (89%) presented with grade 3 disease based on current adult grading scales. Vulvar examination findings most frequently included interlabial and clitoral hood adhesions (89%), loss of architecture of the labia minora or clitoral hood (42%), and skin erosions or fissures (37%). Only 5 patients underwent a speculum exam, none of whom had vaginal GVHD. Examination findings of primary ovarian insufficiency (POI) can overlap with those of GVHD, and 6 patients (32%) in our cohort were diagnosed with POI. Only 1 patient was on systemic hormone replacement therapy at the time of vulvovaginal GVHD diagnosis. The majority of patients (n = 16) were treated with topical steroid therapy, with a median time to response of 43 days. Five patients (26%) had a complete response to therapy, and 10 patients (53%) had a partial response. This case series provides valuable insight into pediatric and young adult vulvovaginal GVHD and highlights the need for increased screening for vulvar disease in this population.

View details for DOI 10.1016/j.bbmt.2019.07.015

View details for Web of Science ID 000505855900012

View details for PubMedID 31325588