Dj. Bauer et al., HISTOLOGIC COMPARISON OF AUTOLOGOUS GRAFT-VS-HOST REACTION AND CUTANEOUS ERUPTION OF LYMPHOCYTE RECOVERY, Archives of dermatology, 129(7), 1993, pp. 855-858
Background and Design.-The cutaneous eruptions due to allogeneic graft
-vs-host disease, autologous graft-vs-host disease, and lymphocyte rec
overy occur in the setting of peripheral leukocyte reconstitution afte
r marrow aplasia. Since the eruptions of lymphocyte recovery (ELR) and
autologous graft-vs-host disease develop in the presence of histocomp
atibility, we question whether reliable histologic differentiation is
possible. To this end, we performed a retrospective, blind analysis of
38 skin biopsy specimens obtained from patients who received autologo
us marrow transplants or intensive chemotherapy alone for various mali
gnant neoplasms. Results.-In 31% of the cases, we were unable to disti
nguish between an ELR and a grade 2 graft-vs-host reaction. In 40% of
the ELR specimens, a significant number of dyskeratotic keratinocytes
were present, leading to the false interpretation of a grade 2 graft-v
s-host reaction. Satellite cell necrosis was observed in both groups.
The patterns of dyskeratotic keratinocytes were similar; one ELR speci
men displayed prominent follicular involvement. Most ELR specimens wer
e consistent with grade 1 graft-vs-host reaction changes. Conclusions.
-These findings indicate that the presence of dyskeratotic keratinocyt
es is not specific for a graft-vs-host reaction and that cutaneous eru
ptions after autologous marrow transplantation are best considered an
ELR.