Histopathologic features of cutaneous acute graft-versus-host disease in T-cell-depleted peripheral blood stem cell transplant recipients Journal Article


Authors: Fischer, A.; Jakubowski, A. A.; Lacouture, M. E.; Hollmann, T. J.; Drucker, A. M.; Maloy, M.; Prockop, S.; Querfeld, C.; Busam, K. J.; Pulitzer, M. P.
Article Title: Histopathologic features of cutaneous acute graft-versus-host disease in T-cell-depleted peripheral blood stem cell transplant recipients
Abstract: 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) after TCD peripheral blood stem cell transplants (PBSCTs) is not described. We identified 13 cases of patients after 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 (vs. focal/absent) basal vacuolization (77% aGVHD vs. 25% non-aGVHD rash), involvement of the entire epidermis (vs. partial thickness) by necrotic keratinocytes (42% aGVHD vs. 0% nonaGVHD rash), and nondense (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. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: adult; clinical article; controlled study; human tissue; aged; human cell; disease course; histopathology; differential diagnosis; acanthosis; keratinocyte; rash; acute graft versus host disease; t cell depletion; peripheral blood stem cell transplantation; graft recipient; exocytosis; cell vacuole; eosinophil; graft-versus-host disease; t-cell depletion; extravasation; human; male; female; priority journal; article; peripheral blood stem cell transplant
Journal Title: American Journal of Dermatopathology
Volume: 37
Issue: 7
ISSN: 0193-1091
Publisher: Lippincott Williams & Wilkins  
Date Published: 2015-07-01
Start Page: 523
End Page: 529
Language: English
PROVIDER: scopus
PUBMED: 26091510
DOI: 10.1097/dad.0000000000000357
PMCID: PMC4966921
DOI/URL:
Notes: Export Date: 2 November 2015 -- Source: Scopus
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MSK Authors
  1. Mario E Lacouture
    365 Lacouture
  2. Susan E Prockop
    226 Prockop
  3. Melissa P Pulitzer
    156 Pulitzer
  4. Klaus J Busam
    599 Busam
  5. Molly Anna Maloy
    249 Maloy