Clinical Significance of Skin Biopsies in the Diagnosis and Management of Graft-vs-Host Disease in Early Postallogeneic Bone Marrow Transplantation

Zhou, Youwen; Barnett, Michael J.; Rivers, Jason K.

doi:10.1001/archderm.136.6.717

Cited by 77 publications

(49 citation statements)

References 16 publications

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“…8 A recent retrospective analysis showed that skin biopsy specimen findings are poorly correlated with the clinical severity of rash suggestive of acute GVHD early after SCT. 9 This study found no significant difference between patients with positive biopsy specimen findings and those with negative biopsy specimen findings, either in the clinical severity of acute GVHD or in the likelihood of receiving treatment for GVHD. They found that the decision to treat suspected acute GVHD depended on clinical suspicion, not on biopsy specimen findings, and, therefore, suggested that skin biopsy has a limited role in the management of eruptions in the early period after SCT.…”

Section: Resultscontrasting

confidence: 56%

Role of Skin Biopsy to Confirm Suspected Acute Graft-vs-Host Disease

Firoz¹,

Lee²,

Nghiem³

et al. 2006

Arch Dermatol

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Section: Resultscontrasting

confidence: 56%

Role of Skin Biopsy to Confirm Suspected Acute Graft-vs-Host Disease

Firoz¹,

Lee²,

Nghiem³

et al. 2006

Arch Dermatol

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“…However, after allogeneic BMT similar aspects can be observed as cutaneous reactions to chemotherapy or radiotherapy, in the eruption of lymphocyte recovery, in adverse drug reactions, and even in some viral infections [1, 3, 4]. Recent studies also suggest a limited role of skin biopsy, since histologic findings are frequently insufficient to differentiate a viral or a hypersensitivity drug eruption from the rash of GvHD, and correlate poorly with the clinical severity or evolution [11, 12]. …”

Section: Discussionmentioning

confidence: 99%

CD8+ Lymphocytes in the Blister Fluid of Severe Acute Cutaneous Graft-versus-Host Disease: Further Similarities with Toxic Epidermal Necrolysis

et al. 2001

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Background: Graft-versus-host disease (GvHD) remains the major toxicity of allogeneic bone marrow transplantation (BMT). In the acute form of the disease, the differential diagnosis includes viral rash and drug eruptions. Methods: We report two patients with chronic myeloid leukemia submitted to allogeneic BMT who developed a severe form of acute cutaneous GvHD, with clinical and histological pictures mimicking toxic epidermal necrolysis (TEN). Results: We found a predominance of peripheral CD8+ T lymphocytes and, at the same time, studying the cellular profile of the blister fluid, just in the beginning of blister eruption, we also found a high proportion of CD8+ T lymphocytes, mainly CD8+CD57–. Conclusion: These data are in agreement with previous reports of the presence of CD8+ T cells in the blister fluid of patients with TEN, further emphasizing similar immunoinflammatory pathways in both diseases.

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“…Therefore, as there are no pathognomonic histological features for GVHD, the value of a biopsy lies mainly in lending support to the clinical diagnosis of GVHD or exclusion of other diseases, depending on the clinical context. Importantly, the number of lymphocytes entering the epidermis and quantity of apoptotic keratinocytes did not prove useful as predictor of the severity of the clinical disease, in contrast to the predictive value of substantial increases in total bilirubin, diarrhea and extent of rash and overall clinical GVHD grade for potentially fatal outcome [82, 83]. Furthermore, skin biopsies of a rather unspecific rash that occurs in the early phase after transplantation have been shown to be of limited value in predicting the progression from rash (viral-induced, drug-induced or early acute GVHD) to overt acute GVHD grade 2–4 irrespective of the stem cell source (peripheral blood, bone marrow).…”

Section: Impact Of Histopathology In the Diagnosis And Prediction Of mentioning

confidence: 99%

Cutaneous Graft-versus-Host Disease: A Guide for the Dermatologist

et al. 2008

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Graft-versus-host disease (GVHD) is defined by the aggregation of clinical and pathological manifestations in a recipient of allogeneic stem cells or bone marrow transplantation in which specific immunological as well as nonspecific phenomena lead to characteristic features. GVHD is one of the major complications after hematopoietic stem cell transplantations and responsible for posttherapeutic morbidity, mortality and decrease in quality of life of those patients. GVHD is critically induced and maintained by donor immunocompetent cells that particularly attack epithelia of fast proliferating tissues such as those from the liver, gastrointestinal tract and skin. On the basis of the time of presentation, cutaneous GVHD has been originally divided into an acute and chronic disease. The latter has traditionally been further subclassified into a more epithelial or lichenoid and a predominantly dermal or sclerodermoid form. With respect to the growing importance of this therapeutic procedure and increasing numbers of outpatients presenting with chronic GVHD, this article summarizes the updated knowledge on this disease focused for the dermatologist, and additionally it emphasizes the recent consensus documents on the various aspects of chronic GVHD of the National Institute of Health.

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Clinical Significance of Skin Biopsies in the Diagnosis and Management of Graft-vs-Host Disease in Early Postallogeneic Bone Marrow Transplantation

Cited by 77 publications

References 16 publications

Role of Skin Biopsy to Confirm Suspected Acute Graft-vs-Host Disease

Role of Skin Biopsy to Confirm Suspected Acute Graft-vs-Host Disease

CD8+ Lymphocytes in the Blister Fluid of Severe Acute Cutaneous Graft-versus-Host Disease: Further Similarities with Toxic Epidermal Necrolysis

Cutaneous Graft-versus-Host Disease: A Guide for the Dermatologist

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