Department of Plastic, Reconstructive and Hand Surgery, University Hospital, Regensburg, Germany.
Department of Internal Medicine III, University of Regensburg, F.J. Strauss Allee 11, 93053, Regensburg, Germany.
Ann Hematol. 2019 Aug;98(8):1867-1875. doi: 10.1007/s00277-019-03687-x. Epub 2019 Apr 16.
Refractory skin ulcers due to severe chronic graft-versus-host disease (cGVHD) remain to be associated with significant morbidity and mortality.We performed an allogeneic donor skin transplantation in seven adult patients after allogeneic hematopoietic stem cell transplantation for cGVHD-associated refractory skin ulcers. While four patients received a split skin graft (SSG), in one patient, a full thickness skin graft for two small refractory ulcers of the ankle was performed, and one patient received in vitro expanded donor keratinocyte grafts derived from hair roots of the original unrelated donor. In one additional patient, a large deep fascial defect of the lower leg was covered with an autologous greater omentum free graft before coverage with an allogeneic SSG. An additional patient was treated with an autologous scrotal skin graft for a refractory ulcer associated with deep sclerosis of cGVHD after unrelated donor transplantation.All skin grafts engrafted and resulted in permanent coverage of the grafted ulcers without any signs of immunological mediated damage. In the patient receiving in vitro expanded keratinocyte grafts, two localized ulcers were permanently covered by donor skin while this approach failed to cover extensive circular ulcers of the lower legs.Allogeneic donor skin grafts are a valuable treatment option in refractory ulcers due to cGVHD but are restricted mainly to related donors while keratinocyte grafts from unrelated donors remain experimental. In male patients lacking a related donor, autologous scrotal skin graft may be an alternative option.
由于严重的慢性移植物抗宿主病 (cGVHD) 导致的难治性皮肤溃疡仍然与显著的发病率和死亡率相关。我们对 7 例因 cGVHD 相关难治性皮肤溃疡而行异基因造血干细胞移植后的成人患者进行了同种异体供体皮肤移植。在 4 例患者中，我们进行了皮肤片移植（SSG），在 1 例患者中，我们对两个踝关节小面积难治性溃疡进行了全层皮肤移植，在 1 例患者中，我们应用了源自原始非亲缘供体毛囊的体外扩增供体角质形成细胞移植。在 1 例额外患者中，我们用自体大网膜游离移植覆盖小腿下部大的深部筋膜缺损，然后再用同种异体 SSG 覆盖。在 1 例接受非亲缘供体移植后因 cGVHD 深部硬化而出现难治性溃疡的患者中，我们应用自体阴囊皮移植进行治疗。所有皮肤移植均成功植入，移植的溃疡永久覆盖，无免疫介导损伤的任何迹象。在接受体外扩增角质形成细胞移植的患者中，2 个局部溃疡被供体皮肤永久性覆盖，而这种方法未能覆盖小腿下部的大面积环状溃疡。同种异体供体皮肤移植是 cGVHD 导致难治性溃疡的一种有价值的治疗选择，但主要限于亲缘供体，而来自非亲缘供体的角质形成细胞移植仍处于实验阶段。对于缺乏亲缘供体的男性患者，自体阴囊皮移植可能是一种替代选择。
