Morphological and immunohistological changes in the skin in allogeneic bone marrow recipients.

Abstract

SUMMARY Skin biopsies from leukaemic patients undergoing allogeneic bone marrow transplantations and treated prophylactically with cyclosporin A were analysed using histological, morphometric, and immunohistological techniques. Samples from donors were used to establish normal values. Biopsies taken from recipients two days before grafting were all histologically normal, but on immunohistological staining half of them showed a reduction in the number of epidermal Langerhans' cells and 29% a reduction in T inducer lymphocytes. Thirty two biopsies were taken from patients with rashes at various times after transplantation: 14 showed lichenoid changes consistent with graft versus host disease, three eczematous tissue reactions, two vesicular lesions, and 12 no histological abnormality. One sample showed changes intermediate between the lichenoid and eczematous forms. The numbers of epidermal Langerhans' cells were low during the first few weeks after transplantation and were normal or raised later regardless of histological appearances. Unlike epidermal Langerhans' cells, significant reductions in the numbers of lymphocytes were not seen.-Lesions of all histological types contained mixtures of T inducer and T suppressor/cytotoxic cells, although the eczematous and vesicular lesions contained higher proportions of T inducer cells. Epidermal infiltrates invariably contained T suppressor/ cytotoxic cells but infiltration of epidermis by T inducer cells occurred only in the presence of normal numbers of epidermal Langerhans' cells. Natural killer cells were not identified. The immunological appearances of the various histological subgroups thus change with time after transplantation.

Differential diagnosis of skin lesions after allogeneic haematopoietic stem cell transplantation

“…The disease is primarily caused by immunocompetent cytotoxic T‐lymphocytes from the donor, reacting against histocompatibility antigens on target tissues of the host. In the skin, the targets are young rete ridge keratinocytes 32 and Langerhans cells 33 …”

Immunohistological Study of Captopril-Induced Late Cutaneous Eruptions

“…The phenotype of the dermal lymphocytic infiltrate does not however allow further extrapolation. In fact, if the lymphocytic infiltrate in GVHD is most often of T suppressor type [23], as in our patient but of T helper type [24] in early lesion of idiopathic lichen planus, however, the infiltrate can also be of the T suppressor type in old lichen planus lesions [25], Kér atinocyte HLA-DR antigen expression is present both in GVHD and idiopathic lichen planus as well as in this case of captoprilinduced lichen.…”

Eczematoid Graft-vs-Host Disease

“…2007;143 (9):1157-1162 G RAFT-VS-HOST DISEASE (GVHD) is a multisystem disease initiated by allogeneic T lymphocytes that recognize foreign tissue antigens in the host. 1 The disease usually develops after hematopoietic stem cell transplantation (HSCT), a therapeutic method used primarily to treat hematologic malignancy.…”

“…6,7 Two reports cite eczemalike GVHD. 8,9 We studied patients who developed cutaneous GVHD after HSCT performed in the Department of Haematological Medicine at King's College Hospital, London, England. Patterns of GVHD manifestation, natural history, response to treatment, and outcome were recorded for all patients.…”