Norton J, Sloane J P
Department of Histopathology, Royal Marsden Hospital, Sutton, Surrey, UK.
Histopathology. 1992 Dec;21(6):529-34. doi: 10.1111/j.1365-2559.1992.tb00440.x.
The relative importance of previous chemotherapy, conditioning and graft v. host disease in producing the epidermal damage associated with allogeneic bone marrow transplantation was investigated by enumerating individually necrotic cells. A small number was seen in many pre-transplant biopsies and was related to the time interval between biopsy and the last dose of chemotherapy. Their presence did not predispose patients to develop graft v. host disease in the post-transplant period. In post-transplant patients without rashes the degree of epidermal damage at 14 days was similar to that seen in the pre-transplant period indicating that the effects of the conditioning regime were insignificant. In patients with rashes clinically classical of graft v. host disease, necrotic cells were increased above the pre-transplant levels even in the absence of a lymphocytic infiltrate. Lymphocytic infiltration was seen more frequently in biopsies taken later after transplantation and after the onset of the rash and was associated with the maximal amount of epidermal damage. Comparison of the degree of epidermal damage in pre- and post-transplantation specimens lacking a lymphocytic infiltrate resulted in the correct identification of the majority of patients with clinical evidence of graft v. host disease. This approach may, thus, be useful in diagnosing early graft v. host disease especially if combined with keratinocyte HLA-DR staining.
通过单独计数坏死细胞，研究了既往化疗、预处理以及移植物抗宿主病在产生与异基因骨髓移植相关的表皮损伤中的相对重要性。在许多移植前活检标本中可见少量坏死细胞，其与活检和最后一剂化疗之间的时间间隔有关。它们的存在并不会使患者在移植后更容易发生移植物抗宿主病。在没有皮疹的移植后患者中，14天时的表皮损伤程度与移植前相似，这表明预处理方案的影响不显著。在临床上有典型移植物抗宿主病皮疹的患者中，即使没有淋巴细胞浸润，坏死细胞也比移植前水平增加。在移植后期和皮疹出现后进行的活检中，淋巴细胞浸润更为常见，且与最大程度的表皮损伤相关。比较缺乏淋巴细胞浸润的移植前和移植后标本中的表皮损伤程度，能够正确识别出大多数有移植物抗宿主病临床证据的患者。因此，这种方法可能有助于早期诊断移植物抗宿主病，特别是与角质形成细胞HLA-DR染色相结合时。
