Normal-looking skin in oncohaematological patients after allogenic bone marrow transplantation is not normal

Vassallo, Camilla; Brazzelli, Valeria; Alessandrino, P E; Varettoni, Marzia; Ardigò, Marco; Lazzarino, Mario; Borroni, G.

doi:10.1111/j.1365-2133.2004.06072.x

Cited by 17 publications

(13 citation statements)

References 45 publications

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“…Rarely, milder forms of this combination of features can occur in skin biopsies from patients with severe clinical acute GVHD. Screening biopsies from non-sun-exposed normal appearing skin, such as iliac crest, taken between day 80 –100 after transplant often contain rare isolated keratinocyte apoptotic bodies with little or no accompanying inflammation [93]. The interpretation of such findings as either non-specific or consistent with minimal (subclinical) GVHD depends on an institution’s minimal diagnostic criteria.…”

Section: Histological Criteria For the Diagnosis Of Gvhdmentioning

confidence: 99%

NIH Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. The 2014 Pathology Working Group Report

Shulman

Cardona

Greenson

et al. 2015

Biology of Blood and Marrow Transplantation

244

242

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The 2005 National Institute of Health (NIH) Consensus Conference outlined histopathological diagnostic criteria for the major organ systems affected by both acute and chronic graft-versus-host disease (GVHD). The 2014 Consensus Conference led to this updated document with new information from histopathological studies of GVHD in the gut, liver, skin and oral mucosa and expanded discussion of GVHD in the lungs and kidneys. The recommendations for final histological diagnostic categories have been simplified from 4 categories to 3: no GVHD, possible, and likely GVHD based on better reproducibility achieved by combining the previous categories of consistent with and definite GVHD into the single category of likely GVHD. Issues remain in the histopathological characterization of GVHD, particularly with respect to the threshold of histological changes required for diagnostic certainty. Guidance is provided for the incorporation of biopsy information into prospective clinical studies of GVHD, particularly with respect to biomarker validation.

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Section: Histological Criteria For the Diagnosis Of Gvhdmentioning

confidence: 99%

NIH Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. The 2014 Pathology Working Group Report

Shulman

Cardona

Greenson

et al. 2015

Biology of Blood and Marrow Transplantation

244

242

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“…They characterized 31% as having GVHD-like patterns including basal vacuolization, a perivascular infiltrate, scattered necrotic keratinocytes in the epidermis and follicular epithelium, and occasional satellitosis. 15 …”

Section: Discussionmentioning

confidence: 99%

Histopathologic Features of Cutaneous Acute Graft-Versus-Host Disease in T-Cell–Depleted Peripheral Blood Stem Cell Transplant Recipients

Fischer

Jakubowski

Lacouture

et al. 2015

The American Journal of Dermatopathology

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T-cell-depleted (TCD) allogeneic hematopoietic stem cell transplantation demonstrates similar efficacy and reduced incidence and severity of graft-versus-host disease (GVHD) in appropriately selected patients versus T-cell-replete transplantation. The histopathology of cutaneous acute GVHD (aGVHD) following TCD peripheral blood stem cell transplants (PBSCT) is not described. We identified 13 cases of patients post TCD-PBSCT, with definitive aGVHD, and 20 cases of non-aGVHD skin rash in patients after TCD-PBSCT, during multidisciplinary review by a dermatopathologist, dermatologist and transplant physician, incorporating clinical presentation, therapeutic response, and histopathology data. Histopathologic features of aGVHD and non-aGVHD skin rash in TCD-PBSCT patients were compared to each other, and also to features recently reported for non-TCD transplant recipients. AGVHD and non-aGVHD skin rash in TCD-PBSCT patients' biopsies had similar rates of epidermal acanthosis, dermal melanophages, neutrophils, plasma cells, eosinophils and extravasated erythrocytes. While satellitosis, exocytosis and adnexal involvement slightly favored aGVHD, more notable differential findings favoring aGVHD, were diffuse (versus focal/absent) basal vacuolization (77% aGVHD vs 25% non-aGVHD rash), involvement of the entire epidermis (versus partial thickness) by necrotic keratinocytes (42% aGVHD vs 0% non aGVHD rash), and non-dense (rather than exuberant) inflammatory infiltrates (77% vs. 20%). After filtering features seen in all TCD samples (epidermal acanthosis, dermal melanophages, neutrophils, plasma cells, eosinophils and extravasated erythrocytes), the most distinct features belonging to aGVHD-positive TCD samples were diffuse basal vacuolization, slight rather than dense inflammatory infiltrates, and necrotic keratinocytes involving the entire epidermis. Awareness of these features may help when evaluating a skin rash occurring after a TCD transplant.

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“…In acute GvHD, the main diagnostic difficulty is between GvHD and a drug reaction, and histology may not distinguish easily between the two 9 . Even if the skin looks clinically normal at day 100 post‐transplant, there may be histological changes of GvHD 10 . The mainstay of treatment is with topical and oral prednisolone.…”

Section: Graft‐versus‐host Diseasementioning

confidence: 99%

“…9 Even if the skin looks clinically normal at day 100 post-transplant, there may be histological changes of GvHD. 10 The mainstay of treatment is with topical and oral prednisolone. Ciclosporin or tacrolimus (or sirolimus) and mycophenolate mofetil are second-line treatments used in the treatment of GvHD of the skin.…”

Section: Graft-versus-host Diseasementioning

confidence: 99%

Recent advances in haematology and oncology: graft-versus-host disease, classification and treatment of non-Hodgkin's lymphomas, and sentinel-node biopsy in breast cancer.

Finucane

Archer

2006

Clin Exp Dermatol

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Normal-looking skin in oncohaematological patients after allogenic bone marrow transplantation is not normal

Abstract: Normal-looking skin in 76% of BMT patients is not necessarily histologically normal. The pattern with more prominent changes, the GvHD-like pattern, has been found to be associated with a more frequent history of CMV antigen in the blood within 100 days from BMT.

Cited by 17 publications

References 45 publications

NIH Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. The 2014 Pathology Working Group Report

NIH Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. The 2014 Pathology Working Group Report

Histopathologic Features of Cutaneous Acute Graft-Versus-Host Disease in T-Cell–Depleted Peripheral Blood Stem Cell Transplant Recipients

Recent advances in haematology and oncology: graft-versus-host disease, classification and treatment of non-Hodgkin's lymphomas, and sentinel-node biopsy in breast cancer.

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