VULVAR AND VAGINAL GRAFT VERSUS HOST DISEASE IN A PATIENT WITH CHRONIC PHASE CHRONIC MYELOID LEUKEMIA AFTER ALLOGENEIC STEM CELL TRANSPLANTATION

Graft versus Host Disease (GVHD) is one of the serious complications of allogeneic stem cell transplantation used in the treatment of many hematological malignancies. Skin, liver, and eyes are frequently affected areas. In addition to frequently affected areas, genital region involvement can also be seen. Allogeneic stem cell transplantation is one of the definitive treatments for hematological malignancies seen in the young age group. And its use for therapeutic purposes in young patients is increasing day by day. Vulvovaginal GVHD is a disease type that concerns female patients of reproductive age. In this case report, we wanted to include in the literature a case that underwent allogeneic stem cell transplantation after CML diagnosis and TKI resistance and then developed vulvovaginal GVHD. In vaginal disease involvement; in addition to many genitourinary complaints, many negativities in sexual life and deterioration in quality of life are experienced. The chronic GVHD patient we treated is currently continuing her treatment response follow-ups. Our aim in presenting this case to the literature is to emphasize that GVHD should be included in the differential diagnosis in female patients with hematological disease and vaginal involvement. 42 years old female patient was diagnosed as chronic phase chronic myeloid leukemia in 2015. She was treated with imatinib 400 mg/day. After 6 months molecular response not obtained and treatment changed to dasatinib 100 mg/day, but after 3 months of dasatinib treatment molecular and hematologic progression occurred and treatment changed to nilotinib and bone marrow transplantation planned. After 4 months the patient transplanted succesfully with HLA matched sibling stem cell donor. Tyrosine Kinase inhibitory used till 1 years after transplantation, Bcr/abl was negative after transplantation and until now. At 2 months of transplantation acute GvHD occurred and healed without any serious complication, but after 10 months symptoms and signs of chronic GvHD developed. Dry skin, itching, dark hyperpigmentation occurred in generalized of the body especially in the upper extremities and ocular GvHD was the main symptoms of the patient. She was used siklosporin and steroids for prophylaxis and treatment of GvHD, also she use ursodeoxycholic acid for liver protection. Chronic GvHD sustained more than 2 years especially ocular findings (drying, itching and scarring of conjunctiva and eyelid). After 5 years of transplantation she