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Kurya AU, Aliyu U, Tudu AI, Usman A, Yusuf M, Gupta S, Ali A, Gulfishan M, Singh SK, Hussain I, Abubakar MG. Graft-versus-host disease: Therapeutic prospects of improving the long-term post-transplant outcomes. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Wegner J, Weidenthaler-Barth B, Engelbert J, Knothe M, Braun C, Helbig D, Sacher C, Kreft A, Wagner EM, Ziemer M, Meyer RG, von Stebut E. Immunohistochemical markers for histopathological diagnosis and differentiation of acute cutaneous graft-versus-host disease. Exp Dermatol 2021; 30:1814-1819. [PMID: 34223669 DOI: 10.1111/exd.14416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/30/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
Graft-versus-host disease (GvHD) is a major complication following stem-cell or solid-organ transplantation. Accurate diagnosis of cutaneous GvHD is challenging, given that drug eruptions and viral rashes may present with similar clinical/histological manifestations. Specific markers are not available. We performed the histological examination of biopsy samples from acute GvHD (aGvHD; n = 54), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN; n = 27), maculopapular drug eruption (MDE; n = 26) and healthy controls (n = 26). Samples of aGvHD showed a decrease in Langerhans cells (LC, p = 0.0001) and an increase in macrophages (MΦ, p = 0.0001) compared to healthy skin. Compared to SJS/TEN, MDE and healthy skin, aGvHD biopsies contained greater numbers of CD4+ and CD8+ T cells. The majority of CD4+ T-helper cells were localized in the upper dermis, whereas cytotoxic CD8+ T cells were found in the epidermis. Increased numbers of CD56+ natural killer (NK) cells in the upper dermis of aGvHD skin (p = 0.007) were not observed in controls or SJS/TEN and MDE. There were no differences in elafin staining between aGvHD and the latter two conditions. Acute GvHD appears to have a distinct inflammatory cell profile (T cells/NK cells) that may aid establishing in a more accurate diagnosis, especially when used to rule out differential diagnoses such as SJS/TEN or MDE.
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Affiliation(s)
- Joanna Wegner
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | - Julia Engelbert
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Max Knothe
- Department of Dermatology, University Hospital of Leipzig, Leipzig, Germany
| | - Claudia Braun
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Doris Helbig
- Department of Dermatology, University Hospital Cologne and Faculty of Medicine Cologne, University of Cologne, Cologne, Germany
| | - Christopher Sacher
- Department of Dermatology, University Hospital Cologne and Faculty of Medicine Cologne, University of Cologne, Cologne, Germany
| | - Andreas Kreft
- Department of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Eva M Wagner
- Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
| | - Mirjana Ziemer
- Department of Dermatology, University Hospital of Leipzig, Leipzig, Germany
| | - Ralf G Meyer
- Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
| | - Esther von Stebut
- Department of Dermatology, University Hospital Cologne and Faculty of Medicine Cologne, University of Cologne, Cologne, Germany
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García-Romero MT, Sáez-de-Ocariz M, Hernández-Zepeda C, Reyes M, García de la Puente S, Ridaura-Sanz C, López-Hernández G, Olaya-Vargas A. Early clinical, histological, and immunohistochemical findings in suspected acute graft-versus-host disease and their association with patient outcomes. Pediatr Dermatol 2020; 37:613-621. [PMID: 32242989 DOI: 10.1111/pde.14152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Acute graft-versus-host disease (aGVHD) is a serious condition after allogeneic hematopoietic stem cell transplantation (HSCT), frequently involving skin, gut, and liver. It can be difficult to diagnose early, yet this is vital for adequate management. We sought to identify initial clinical and histopathological features in children with suspected GVHD and the association with clinical course and outcomes. METHODS Retrospective study of patients with skin biopsies for suspected aGVHD from 2006 to 2016. We collected demographic and clinical information, histologic, and immunohistochemical (IHC) findings, and outcomes during follow-up. Bivariate and multivariate analyses were done to identify risk factors associated with remission, development of severe/life-threatening aGVHD, and mortality. RESULTS We included 42 patients, 15 females. Skin manifestations occurred 51 days (median) after HSCT. On biopsy, 76.2% had mild (stage 1-2) skin aGVHD; during the course of the disease, severity and systemic involvement increased to global grade III/IV in 66.6%. All patients received treatment; 15 are in remission from aGVHD and 23 have died. Histologic features were diagnostic in 83.3%. On bivariate and multivariate analysis, we identified initial clinical and histologic findings that were associated with the measured outcomes: odds of remission from aGVHD were increased when focal vacuolar changes were found on skin biopsy (OR 6.028; 95%CI:1.253-28.992) but decreased by initial hepatic aGVHD (OR 0.112; 95%CI: 0.017-0.748); severe/life-threatening aGVHD was associated with initial gastrointestinal aGVHD (OR 6.054; 95%CI:1.257-29.159); and odds of mortality were decreased with male donor (OR 0.056; 95%CI:0.004-0.804), nulliparous female donor (OR 0.076; 95%CI:0.009-0.669), and focal vacuolar changes on skin biopsy (OR 0.113; 95%CI:0.017-0.770). CONCLUSIONS We found novel indicators predictive of remission, severity, and mortality in children with aGVHD. Further studies of this condition in children are needed.
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Affiliation(s)
| | | | | | - Montserrat Reyes
- Department of Pathology, National Institute for Pediatrics, Mexico City, Mexico
| | | | | | - Gerardo López-Hernández
- Department of Hematopoietic Stem Cell Transplantation, National Institute for Pediatrics, Mexico City, Mexico
| | - Alberto Olaya-Vargas
- Department of Hematopoietic Stem Cell Transplantation, National Institute for Pediatrics, Mexico City, Mexico
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Morán-Villaseñor E, Serrano-Pacheco C, Orozco-Covarrubias L, Murata C, Rodríguez-Jurado R, Olaya-Vargas A, Saez-de-Ocariz M. Are apoptosis-determining techniques useful to establish an early diagnosis of acute graft-vs-host disease in pediatric patients under treatment with multiple drugs? J Cutan Pathol 2020; 47:517-523. [PMID: 32031289 DOI: 10.1111/cup.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/15/2020] [Accepted: 01/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are no pathognomonic histopathological features to distinguish acute graft-vs-host disease (aGVHD) from skin drug reactions (SDRs) in pediatric patients with multiple drug regimens that have received blood transfusions and/or transplants. We aimed to determine if the addition of apoptosis markers is helpful to distinguish aGVHD from SDRs in these patients. METHODS Skin biopsy specimens from patients with a clinical diagnosis of aGVHD or SDRs were evaluated for the presence of apoptotic bodies, satellitosis, interface damage, vasculitis, and inflammatory infiltrate on H&E stain. Information was completed with apoptotic markers (transferase-mediated dUTP nick end-labeling [TUNEL], bcl-2, and caspase-3). RESULTS The skin biopsy specimens of 32 patients with aGVHD and 11 with SDRs were included for study. Only the number of apoptotic keratinocytes per 10 high-power fields (hpf) showed a significant difference between both groups (P = 0.02); the presence of ≥4 apoptotic keratinocytes per 10 hpf was identified as the optimal cut-off point to discriminate aGVHD from SDRs. No SDRs cases had follicular apoptotic cells. TUNEL, bcl-2, and caspase-3 determination showed no difference between both groups. CONCLUSIONS The presence of ≥4 apoptotic keratinocytes per 10 hpf (in aGVHD) and the absence of follicular apoptotic cells (in SDRs) might be a useful marker to distinguish between them.
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Affiliation(s)
| | | | | | - Chiharu Murata
- Department of Research Methodology, National Institute of Pediatrics, Mexico City, Mexico
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Menter T, Medani H, Olavarria E, Kanfer E, Naresh KN. Pathology findings in patients with cutaneous T-cell lymphomas treated with allogeneic haematopoietic stem cell transplantation. Br J Haematol 2016; 180:904-908. [DOI: 10.1111/bjh.14479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Menter
- Department of Cellular and Molecular Pathology; Hammersmith Hospital Campus; Imperial College Healthcare NHS Trust; London UK
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - Hanine Medani
- Department of Cellular and Molecular Pathology; Hammersmith Hospital Campus; Imperial College Healthcare NHS Trust; London UK
| | - Eduardo Olavarria
- Department of Haematology; Hammersmith Hospital Campus, Imperial College Healthcare NHS Trust; London UK
| | - Edward Kanfer
- Department of Haematology; Hammersmith Hospital Campus, Imperial College Healthcare NHS Trust; London UK
| | - Kikkeri N. Naresh
- Department of Cellular and Molecular Pathology; Hammersmith Hospital Campus; Imperial College Healthcare NHS Trust; London UK
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Riesner K, Kalupa M, Shi Y, Elezkurtaj S, Penack O. A preclinical acute GVHD mouse model based on chemotherapy conditioning and MHC-matched transplantation. Bone Marrow Transplant 2015; 51:410-7. [PMID: 26595081 DOI: 10.1038/bmt.2015.279] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/12/2015] [Accepted: 10/16/2015] [Indexed: 12/31/2022]
Abstract
Animal disease models have been criticized for lack of resemblance to human illnesses, hampering transfer of knowledge from preclinical research to clinical medicine. In the field of allogeneic hematopoietic stem cell transplantation (allo-HSCT), it is standard practice to study GVHD in lethal TBI-based murine models. Frequently, MHC-mismatched donors are used in GVHD models. In contrast, in clinical allo-HSCT conditioning with chemotherapy (+/-TBI) is common and donors are often MHC-matched. Aiming at a more clinically oriented situation, we established and characterized a murine MHC-matched, minor histocompatibility antigen mismatched GVHD model (LP/J [H2k(b)]-->C57BL/6 [H2k(b)]) using busulfan and cyclophosphamide conditioning. We found typical clinical and histological features of acute GVHD. T-cell infiltration, GVHD-specific damage and systemic inflammation were similar to observations made in patients after allo-HSCT. In survivors of acute GVHD, we found expansion of CD4+ T cells and the development of scleroderma-like chronic GVHD. The use of chemotherapy-based, minor histocompatibility antigen (miHA)-mismatched GVHD animal models may be a good option when studying clinically relevant questions in the field of allo-HSCT.
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Affiliation(s)
- K Riesner
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Berlin, Germany
| | - M Kalupa
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Berlin, Germany
| | - Y Shi
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Berlin, Germany
| | - S Elezkurtaj
- Institute for Pathology, Charité University Medicine, Berlin, Germany
| | - O Penack
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Berlin, Germany
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Krivolapova AYU, Smirnova IO, Lisukova YEV, Moiseyev IS, Belousova IE, Baikov VV. Clinical and morphological diagnostics of skin manifestations in case of graft-versus-host disease. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-3-96-103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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.
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Toxic Epidermal Necrolysis and Graft-versus-Host Reaction: Revisiting a Puzzling Similarity. ISRN DERMATOLOGY 2013; 2013:651590. [PMID: 23862070 PMCID: PMC3686138 DOI: 10.1155/2013/651590] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/12/2013] [Indexed: 12/14/2022]
Abstract
Drug-induced toxic epidermal necrolysis (TEN) and acute cutaneous graft-versus-host reaction (GVHR) under immunopreventive therapy share some histopathological resemblance. So far, there are no serum biomarkers and no immunohistochemical criteria distinguishing with confidence and specificity the skin lesions of TEN and GVHR. Both diseases present as an inflammatory cell-poor necrotic reaction of the epidermis. This report compares three sets of 15 immunostaining patterns found in TEN, GVHR, and partial thickness thermal burns (PTTB), respectively. Three series of 17 skin biopsies were scrutinized. Irrespective of the distinct causal pathobiology of TEN and GVHR, similar secondary effector cells were recruited in lesional skin. Burns were less enriched in cells of the monocyte-macrophage disease. These cells likely exert deleterious effects in TEN and GVHR and cannot be simply regarded as passive bystanders. These life-threatening conditions are probably nursed, at least in part, by macrophages.
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Sadeghi B, Aghdami N, Hassan Z, Forouzanfar M, Rozell B, Abedi-Valugerdi M, Hassan M. GVHD after chemotherapy conditioning in allogeneic transplanted mice. Bone Marrow Transplant 2008; 42:807-18. [DOI: 10.1038/bmt.2008.261] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Häusermann P, Walter RB, Halter J, Biedermann BC, Tichelli A, Itin P, Gratwohl A. Cutaneous graft-versus-host disease: a guide for the dermatologist. Dermatology 2008; 216:287-304. [PMID: 18230976 DOI: 10.1159/000113941] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 09/18/2007] [Indexed: 01/05/2023] Open
Abstract
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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Affiliation(s)
- Peter Häusermann
- Department of Dermatology, University Hospital Basel, Basel, Switzerland.
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