Horn T D, Zahurak M L, Atkins D, Solomon A R, Vogelsang G B
Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Md., USA.
Arch Dermatol. 1997 Aug;133(8):961-5.
The discrimination between acute and chronic graft-vs-host disease (GVHD) after allogeneic bone marrow transplantation (BMT) is important because the treatment regimens and prognosis differ.
To identify whether accepted histopathologic criteria of a graft-vs-host reaction (GVHR) alone or in combination accurately reflect clinical phase of disease, to correlate patterns with clinical outcome, and to identify any concordance between inflammation and epidermal changes of a GVHR.
Skin biopsy specimens were analyzed according to histologically defined standards.
This study was performed in a tertiary care hospital.
One hundred seventy-three skin biopsy specimens (10 days before to 1326 days after BMT) from 83 patients undergoing allogeneic BMT for various malignant neoplasms were selected for study. A consecutive 12-month sample was used.
The main measures in this study were statistical correlations between histopathologic findings and time after BMT, the outcome of BMT, and the correlations between selected histopathologic criteria.
Fully evolved histologic features of chronic lichenoid GVHR in the specimens occurred across a wide time range (33-832 days after BMT) and were associated with a 5.6-fold increased risk for death (P = .02) from GVHD. Histologic features of acute GVHR in the specimens also occurred across a wide time range (14-481 days after BMT) and were associated with a 2.2-fold increased risk for death; this finding was not statistically significant (P = .11). Inflammation of the upper dermis was significantly associated with acanthosis and epidermal cell necrosis (P < .001 and P < .001, respectively, for bandlike pattern), confirming the importance of this finding as a criterion for the diagnosis of a GVHR. Blinded evaluation of a subset of specimens for the diagnosis of acute vs chronic GVHR resulted in wide interobserver variation.
This study demonstrates the following: specific histologic parameters in skin biopsy specimens do not consistently separate acute from chronic GVHD as defined by days after BMT; independent of time course, fully evolved histopathologic characteristics of a lichen planus-like GVHR is associated with a greater likelihood of death from GVHD; and identification of upper dermal inflammation correlates with the epidermal features of GVHR and should be included in the diagnostic scheme.
异基因骨髓移植（BMT）后急性与慢性移植物抗宿主病（GVHD）的鉴别很重要，因为治疗方案和预后不同。
确定公认的移植物抗宿主反应（GVHR）组织病理学标准单独或联合使用是否能准确反映疾病的临床阶段，将病理模式与临床结果相关联，并确定GVHR炎症与表皮变化之间的一致性。
根据组织学定义的标准对皮肤活检标本进行分析。
本研究在一家三级医疗中心进行。
选取83例因各种恶性肿瘤接受异基因BMT患者的173份皮肤活检标本（BMT前10天至BMT后1326天）进行研究。采用连续12个月的样本。
本研究的主要指标是组织病理学结果与BMT后时间、BMT结局之间的统计相关性，以及选定组织病理学标准之间的相关性。
标本中慢性苔藓样GVHR的完全演变组织学特征出现在广泛的时间范围内（BMT后33 - 832天），且与GVHD导致的死亡风险增加5.6倍相关（P = 0.02）。标本中急性GVHR的组织学特征也出现在广泛的时间范围内（BMT后14 - 481天），且与死亡风险增加2.2倍相关；这一发现无统计学意义（P = 0.11）。真皮上层炎症与棘皮症和表皮细胞坏死显著相关（带状模式分别为P < 0.001和P < 0.001），证实了这一发现作为GVHR诊断标准的重要性。对一部分标本进行急性与慢性GVHR诊断的盲法评估导致观察者间差异很大。
本研究表明：皮肤活检标本中的特定组织学参数不能根据BMT后天数始终如一地区分急性与慢性GVHD；与时间进程无关，扁平苔藓样GVHR的完全演变组织病理学特征与GVHD导致死亡的可能性更大相关；真皮上层炎症的识别与GVHR的表皮特征相关，应纳入诊断方案。
