Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Int J Dermatol. 2021 Jan;60(1):60-69. doi: 10.1111/ijd.15186. Epub 2020 Sep 29.
Prompt management of acute graft-versus-host disease (GVHD) may prevent its morbidity and mortality. Maculopapular (MP) eruption is a presenting sign of acute GVHD, but differentiation from other causes of MP rash is challenging.
A retrospective study was conducted among patients developing MP eruptions after allogeneic hematopoietic stem cell transplantation. We compared the clinical and histopathological differences between an acute cutaneous GVHD (group 1) and other MP eruptions (group 2). We also determined the clinical prognostic indicators linked to acute GVHD severity, morbidity, and mortality.
Of 95 patients identified, 75 met the classification criteria for acute GVHD, and 25 had other MP eruptions. Palm and/or sole involvement was more frequently found (51.4% vs. 12%, odds ratio [OR] [95% confidence interval] = 7 [2.1, 23.7], P < 0.01 and 41.4% vs. 0%, OR 37.2 [2.2, 635], P < 0.01, respectively) in group 1 than in group 2. Comparing the histological features between the two groups, necrotic keratinocytes in basal and spinous layers (92.9% vs. 22.2%, OR 27 [3.5, 594.7], P < 0.01) and (85.7% vs. 33.3%, OR 9.3 [1.4, 60.8], P = 0.02, respectively), diffuse basal vacuolization (42.9% vs. 0%, OR 14.5 [0.7, 298.2], P = 0.04), lymphocyte satellitosis (71.4% vs. 0%, OR 44.3 [2.1, 936.8], P < 0.01), and subepidermal clefts (42.9% vs. 0%, OR 14.5 [0.7, 298.2], P = 0.04) were significantly more apparent in group 1. Among extracutaneous presentations, diarrhea alone and/or accompanied by hyperbilirubinemia (47.1% vs. 16%, OR 4.3 [1.4, 13.1], P = 0.03 and 27.1% vs. 0%, OR 19.3 [1.1, 332.8], P < 0.01, respectively) and newly developed transaminitis (37.1% vs. 12%, OR 3.3 [1.1, 12.6], P = 0.02) suggested the diagnosis of acute GVHD. Mucosal involvement and/or blister formation correlated with severe acute GVHD (OR 26.6 [5.4, 130.4], P < 0.01). Skin and systemic GVHD severity correlated with time to rash resolution (P = 0.03 and P = 0.04, respectively), length of hospital stays (P < 0.01 and P < 0.01, respectively), and mortality (OR 4.87 [1.4, 17.4], P = 0.02 and OR 4.6 [1.3, 16.5], P = 0.02, respectively).
Our findings may be beneficial tools for establishing the diagnosis of acute GVHD.
急性移植物抗宿主病（GVHD）的及时治疗可能会预防其发病率和死亡率。斑丘疹（MP）疹是急性 GVHD 的一个表现，但区分其他导致 MP 疹的原因具有挑战性。
对接受异基因造血干细胞移植后出现 MP 疹的患者进行了回顾性研究。我们比较了急性皮肤 GVHD 组（第 1 组）和其他 MP 疹组（第 2 组）的临床和组织病理学差异。我们还确定了与急性 GVHD 严重程度、发病率和死亡率相关的临床预后指标。
在确定的 95 名患者中，75 名符合急性 GVHD 的分类标准，25 名患有其他 MP 疹。手掌和/或脚底受累更常见（51.4%比 12%，比值比[OR] [95%置信区间]为 7 [2.1，23.7]，P < 0.01 和 41.4%比 0%，OR 37.2 [2.2，635]，P < 0.01）在第 1 组比在第 2 组。比较两组的组织学特征，基底和棘层坏死角质形成细胞（92.9%比 22.2%，OR 27 [3.5，594.7]，P < 0.01）和（85.7%比 33.3%，OR 9.3 [1.4，60.8]，P = 0.02）、弥漫性基底空泡化（42.9%比 0%，OR 14.5 [0.7，298.2]，P = 0.04）、淋巴细胞卫星现象（71.4%比 0%，OR 44.3 [2.1，936.8]，P < 0.01）和表皮下裂隙（42.9%比 0%，OR 14.5 [0.7，298.2]，P = 0.04）在第 1 组中更明显。在皮肤外表现中，单独腹泻伴或不伴高胆红素血症（47.1%比 16%，OR 4.3 [1.4，13.1]，P = 0.03 和 27.1%比 0%，OR 19.3 [1.1，332.8]，P < 0.01）和新出现的氨基转移酶升高（37.1%比 12%，OR 3.3 [1.1，12.6]，P = 0.02）提示急性 GVHD 的诊断。黏膜受累和/或水疱形成与严重急性 GVHD 相关（OR 26.6 [5.4，130.4]，P < 0.01）。皮肤和全身 GVHD 严重程度与皮疹消退时间相关（P = 0.03 和 P = 0.04）、住院时间（P < 0.01 和 P < 0.01）和死亡率（OR 4.87 [1.4，17.4]，P = 0.02 和 OR 4.6 [1.3，16.5]，P = 0.02）。
我们的研究结果可能有助于建立急性 GVHD 的诊断。
