Hymes S R, Farmer E R, Lewis P G, Tutschka P J, Santos G W
J Am Acad Dermatol. 1985 Mar;12(3):468-74. doi: 10.1016/s0190-9622(85)70065-5.
Acute graft-versus-host disease (GVHD) is a severe complication of bone marrow transplantation. The diagnosis may be made and its course followed by serial skin biopsies. The degree of epidermal change has been used as a guideline in grading each biopsy, but great variation may be found within each grade, especially grade 2 (basal cell vacuolization and dyskeratosis). To find a histologic parameter that is prognostic of more severe acute GVHD, we examined retrospectively the serial biopsies of 54 patients. When we studied early cutaneous graft-versus-host reaction (GVHR), represented by the grade 2 biopsies, the number of dermal and epidermal mononuclear inflammatory cells correlated positively with the probability of developing more severe acute GVHD. In addition, the patients who had more severe acute GVHD tended to have an earlier appearance of cutaneous histologic changes. None of the other histologic parameters examined in these grade 2 biopsies were found to be predictive of GVHD progression. In addition, no histopathologic parameters in these grade 2 biopsies were predictive of the subsequent development of chronic GVHD.
急性移植物抗宿主病（GVHD）是骨髓移植的一种严重并发症。可通过系列皮肤活检做出诊断并跟踪其病程。表皮变化程度已被用作对每次活检进行分级的指导，但每个级别内可能存在很大差异，尤其是2级（基底细胞空泡化和角化不良）。为了找到一个能预测更严重急性GVHD的组织学参数，我们回顾性检查了54例患者的系列活检。当我们研究以2级活检为代表的早期皮肤移植物抗宿主反应（GVHR）时，真皮和表皮单核炎性细胞的数量与发生更严重急性GVHD的可能性呈正相关。此外，患有更严重急性GVHD的患者往往皮肤组织学变化出现得更早。在这些2级活检中检查的其他组织学参数均未发现可预测GVHD的进展。此外，这些2级活检中的组织病理学参数均不能预测慢性GVHD的后续发展。
