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[皮肤移植物抗宿主病]

[Cutaneous graft-versus-host disease].

作者信息

Karrer S

机构信息

Klinik und Poliklinik für Dermatologie, Universität Regensburg.

出版信息

Hautarzt. 2003 May;54(5):465-80; quiz 481-2. doi: 10.1007/s00105-003-0528-z.

DOI:10.1007/s00105-003-0528-z
PMID:12833893
Abstract

Although stem cell transplantation is a life-saving measure and the treatment of choice for many patients with various hematologic malignancies, a high incidence of complications and a transplantation associated mortality of about 30% are to be expected.Graft-versus-Host Disease (GvHD) is the major cause of morbidity and mortality after stem cell transplantation. GvHD can arise at various time points. Acute GvHD occurs during the first 100 days after transplantation in up to 50% of graft recipients, while chronic GvHD develops in about 30-50% usually within 100-500 days following allogeneic stem cell transplantation. It can involve the skin, liver, gastrointestinal tract, and less frequently the lungs, eyes and neuromuscular system. Early diagnosis of GvHD can be difficult, as drug reactions, viral infections and cutaneous reactions to radiation therapy may have clinical and histological similarities. In this review, the various cutaneous manifestations of GvHD, the histopathologic features, prophylaxis and therapy of acute and chronic GvHD are discussed in light of the recent literature.

摘要

尽管干细胞移植是一项挽救生命的措施,也是许多各种血液系统恶性肿瘤患者的首选治疗方法,但预计并发症的发生率较高,且与移植相关的死亡率约为30%。移植物抗宿主病(GvHD)是干细胞移植后发病和死亡的主要原因。GvHD可在不同时间点出现。急性GvHD发生在移植后的前100天内,高达50%的移植受者会出现,而慢性GvHD通常在异基因干细胞移植后的100 - 500天内发生,约30 - 50%的患者会出现。它可累及皮肤、肝脏、胃肠道,较少累及肺、眼睛和神经肌肉系统。GvHD的早期诊断可能困难,因为药物反应、病毒感染和放疗后的皮肤反应可能在临床和组织学上有相似之处。在本综述中,根据最近的文献讨论了GvHD的各种皮肤表现、急性和慢性GvHD的组织病理学特征、预防和治疗。

相似文献

1
[Cutaneous graft-versus-host disease].[皮肤移植物抗宿主病]
Hautarzt. 2003 May;54(5):465-80; quiz 481-2. doi: 10.1007/s00105-003-0528-z.
2
[Cutaneous manifestations of graft-versus-host disease].移植物抗宿主病的皮肤表现
Med Klin (Munich). 2001 Aug 15;96(8):457-66. doi: 10.1007/pl00002228.
3
Histological evaluation of acute mucocutaneous graft-versus-host disease in nonmyeloablative hematologic stem cell transplants with an observation predicting an increased risk of progression to chronic graft-versus-host disease.非清髓性造血干细胞移植中急性黏膜皮肤移植物抗宿主病的组织学评估及一项预测进展为慢性移植物抗宿主病风险增加的观察结果。
Am J Dermatopathol. 2007 Feb;29(1):1-6. doi: 10.1097/01.dad.0000246173.96318.0c.
4
Isomorphic cutaneous graft-versus-host disease reaction after ultraviolet exposure: clinical, histological and direct immunofluorescence studies of four allo-transplanted patients.紫外线照射后同形性皮肤移植物抗宿主病反应:4例同种异体移植患者的临床、组织学及直接免疫荧光研究
J Eur Acad Dermatol Venereol. 2009 Aug;23(8):913-8. doi: 10.1111/j.1468-3083.2009.03220.x.
5
Apoptosis is the mode of keratinocyte death in cutaneous graft-versus-host disease.
J Am Acad Dermatol. 1996 Aug;35(2 Pt 1):187-90. doi: 10.1016/s0190-9622(96)90320-5.
6
Immunohistochemistry of cutaneous graft-versus-host disease after allogeneic bone marrow transplantation.异基因骨髓移植后皮肤移植物抗宿主病的免疫组织化学
J Dermatol. 1991 Jun;18(6):314-23. doi: 10.1111/j.1346-8138.1991.tb03091.x.
7
[Histopathology of graft-versus-host disease].[移植物抗宿主病的组织病理学]
Pathologe. 2011 Mar;32(2):144-51. doi: 10.1007/s00292-010-1408-9.
8
Role of skin biopsy to confirm suspected acute graft-vs-host disease: results of decision analysis.皮肤活检在确诊疑似急性移植物抗宿主病中的作用:决策分析结果
Arch Dermatol. 2006 Feb;142(2):175-82. doi: 10.1001/archderm.142.2.175.
9
Human cutaneous graft-versus-host disease.
J Invest Dermatol. 1985 Jul;85(1 Suppl):124s-128s. doi: 10.1111/1523-1747.ep12275636.
10
Atopic dermatitis-like presentation of graft-versus-host disease: a novel form of chronic cutaneous graft-versus-host disease.移植物抗宿主病样表现:一种新型慢性皮肤移植物抗宿主病。
J Am Acad Dermatol. 2013 Jul;69(1):34-9. doi: 10.1016/j.jaad.2012.12.970. Epub 2013 Feb 1.

引用本文的文献

1
[Graft-versus-Host Disease (GvHD) - an update : Part 1: Pathophysiology, clinical features and classification of GvHD].[移植物抗宿主病(GvHD)——最新进展:第1部分:GvHD的病理生理学、临床特征及分类]
Hautarzt. 2011 Feb;62(2):139-54; quiz 155. doi: 10.1007/s00105-010-2107-4.

本文引用的文献

1
Allogeneic hematopoietic stem cell transplantation: complications and results.异基因造血干细胞移植:并发症与结果
Arch Intern Med. 2002 Jul 22;162(14):1558-66. doi: 10.1001/archinte.162.14.1558.
2
Novel pharmacotherapeutic approaches to prevention and treatment of GVHD.预防和治疗移植物抗宿主病的新型药物治疗方法。
Drugs. 2002;62(6):879-89. doi: 10.2165/00003495-200262060-00002.
3
[Cutaneous manifestations of graft-versus-host disease].移植物抗宿主病的皮肤表现
Med Klin (Munich). 2001 Aug 15;96(8):457-66. doi: 10.1007/pl00002228.
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Chronic graft-versus-host disease after allogeneic blood stem cell transplantation.
Blood. 2001 Sep 15;98(6):1695-700. doi: 10.1182/blood.v98.6.1695.
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Unrelated donor hematopoietic transplantation.
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How I treat chronic graft-versus-host disease.我如何治疗慢性移植物抗宿主病。
Blood. 2001 Mar 1;97(5):1196-201. doi: 10.1182/blood.v97.5.1196.
7
Late appearance of acute graft-vs-host disease after suspending or tapering immunosuppressive drugs.
Arch Dermatol. 2001 Jan;137(1):61-5. doi: 10.1001/archderm.137.1.61.
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Management of graft-versus-host disease.移植物抗宿主病的管理
Blood Rev. 2000 Dec;14(4):190-204. doi: 10.1054/blre.2000.0137.
9
Recipient tumor necrosis factor-alpha and interleukin-10 gene polymorphisms associate with early mortality and acute graft-versus-host disease severity in HLA-matched sibling bone marrow transplants.在人类白细胞抗原匹配的同胞骨髓移植中,受体肿瘤坏死因子-α和白细胞介素-10基因多态性与早期死亡率及急性移植物抗宿主病严重程度相关。
Blood. 1999 Dec 1;94(11):3941-6.
10
Cytokines in GvH and GvL.
Bone Marrow Transplant. 1998 Dec;22 Suppl 4:S3-6.