Clinical and morphological diagnostics of skin manifestations in case of graft-versus-host disease

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Abstract

The graft-versus-host disease is a life-threatening complication of allogeneic bone marrow transplantation, which demands fast and reliable diagnostics. Goal. To study clinical features of the graft-versus-host disease as well as differential and diagnostic value of histological and immunohistochemical signs in skin biopsy samples in case of graft-versus-host disease (GvHD). Materials and methods. The authors made a comparative assessment of clinical data available for patients suffering from acute GvHD (50 patients) and toxic dermatitis (10 patients). Skin biopsy samples taken from patients from both groups underwent postmortem and immunohistochemistry examinations: the drugs were stained with hematoxylin and eosin as well as by using anti-CD3, CD20, CD4, CD8, FOXP3, CD56, CD1a and CD 68 antibodies. Results. Based on the results of clinical data assessments, no significant differences in the groups were revealed. The morphological examination revealed that the number of eosinophils, CD8+, CD1a+, CD3+ and FOXP3+ cells and share of FOXP3+ cells among Т lymphocytes was higher in the group with toxic dermatitis. Conclusion. An integrated assessment of clinical data and morphological examination results accompanied by the analysis of the population composition of the infiltrate is needed to diagnose the acute GvHD.

About the authors

A. YU. Krivolapova

Saint Petersburg State Medical University

Author for correspondence.
Email: akrivolapova@gmail.com
Россия

I. O. Smirnova

Saint Petersburg State University

Email: noemail@neicon.ru
Россия

YE. V. Lisukova

Saint Petersburg State Medical University

Email: noemail@neicon.ru
Россия

I. S. Moiseyev

Saint Petersburg State Medical University

Email: noemail@neicon.ru
Россия

I. E. Belousova

Military Medical Academy named after S.M. Kirov Ministry of Defense of the Russian Federation

Email: noemail@neicon.ru
Россия

V. V. Baikov

Saint Petersburg State Medical University

Email: noemail@neicon.ru
Россия

References

  1. Shulman H., Kleiner D., Lee S. et al. Histopathologic Diagnosis of Chronic Graft-versus-Host Disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. Pathology Working Group Report. Biology of Blood and Marrow Transplantation. 2006; 12 (1): 31-47.
  2. Marra D.E., Mckee P.H., Nqhiem P. Tissue eosinophils and the perils of using skin biopsy specimens to distinguish between drug hypersensitivity and cutaneous graft-versus-host disease. Journal of the American Academy of Dermatology. 2007; 51 (4): 543-546.
  3. Jacobsohn D.A., Vogelsang G. Acute graft versus host disease. Orphanet journal of Rare Diseases. 2007; 4 (2): 35.
  4. Glucksberg H., Storb R., Fefer A. et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation. 1974; 18: 295-304.
  5. Byun H.J., Yang J.I., Kim B.K. Clinical differentiation of acute cutaneous graft-versus-host disease from drug hypersensitivity reactions. Journal of the American Academy of Dermatology. 2011; 65 (4): 726. Литература
  6. Heldal D., Brinch L., Evensen S.A. et al. Skin biopsies for early diagnosis and prognosis of graft-versus-host disease in recipients of allogeneic stem cells from blood or bone marrow. Bone Marrow Transplantation. 2004; 34 (4): 345-350.
  7. Ziemer M., Haeusermann P., Janin A. et al. Histopathological diagnosis of graft-versus-host disease of the skin - an interobserver comparison. Journal of the European Academy of Dermatology and Venereology. 2014 Jul; 28 (7): 915-924.
  8. Zhou Y., Barnett M.J., Rivers J.K. Clinical significance of skin biopsies in the diagnosis and management of graft-versus-host disease in early postallogeneic bone marrow transplantation. Archives of dermatology. 2000; 136 (6): 717-721.
  9. Przepiorka D., Weisdorf D., Martin P. et al. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant. 1995; 15 (6): 825-8.
  10. National Cancer Institute - PDQ Cancer Information Summaries. Adult Acute Myeloid Leukemia Treatment. 2014 Mar.
  11. Weedon D. Weedon's Skin Pathology. 3rd ed. London: Churchill Livingstone Elsevier. 2010: 36-37.
  12. Lerner K.G., Kao G.F., Storb R. et al. Histopathology of graft-vs.-host reaction (GvHR) in human recipients of marrow from HL-A-matched sibling donors. Transplantation Proceedings. 1974; 6 (4): 367-371.
  13. Murphy G.F., Korngold R. Significance of selectively targeted apoptotic rete cells in graft-versus-host disease. Biology of Blood and Marrow Transplantation. 2004; 10 (6): 357-365.
  14. Yan B., Da W. CD4+CD25+ regulatory T cells and their function in graft-versus-host disease-review. Journal of experimental hematology Chinese Association of Pathophysiology. 2006; 14 (2): 408-412.
  15. Rezvani K., Mielke S., Ahmadzadeh M. et al. High donor FOXP3-positive regulatory T-cell (Treg) content is associated with a low risk of GVHD following HLA-matched allogeneic SCT. Bllod. 2006; 108 (4): 1291-1297.
  16. Li Q., Zhai Z., Xu X. et al. Decrease of CD4+CD25+ regulatory T cells and TGF- at early immune reconstitution is associated to the onset and severity of graft-versus-host disease following allogeneic haematogenesis stem cell transplantation. Leukemia Research. 2010; 34 (9): 1158-1168.
  17. Fondi C., Nozolli C., Benemei S. et al. Increase in FOXP3+ Regulatory T Cells in GVHD Skin Biopsies Is Associated with Lower Disease Severity and Treatment Response. Biology of Blood and Marrow Transplantation. 2009; 15 (8): 938-947.
  18. Wolf D., Wolf A.M., Fong D. et al. Regulatory T-cells in the graft and the risk of acute graft-versus-host disease after allogeneic stem cell transplantation. Transplantation. 2007 Apr 27; 83 (8): 1107-13.
  19. Chakraverty R., Sykes M. The role of antigen-presenting cells in triggering graft-versus-host disease and graft-versus-leukemia. Blood. 2007; 110: 9-17.
  20. Andani R., Robertson I., Macdonald K.P. et al. Origin of Langerhans cells in normal skin and chronic GVHD after hematopoietic stem-cell transplantation. Experimental Dermatology. 2014; 23 (1): 75-77.
  21. Li H., Kaplan D., Matte-Martone C. et al. Langerhans cells are not required for graft-versus-host disease. Blood. 2011; 117 (2): 697-707.

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Copyright (c) 2015 Krivolapova A.Y., Smirnova I.O., Lisukova Y.V., Moiseyev I.S., Belousova I.E., Baikov V.V.

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