HISTOLOGIC COMPARISON OF AUTOLOGOUS GRAFT-VS-HOST REACTION AND CUTANEOUS ERUPTION OF LYMPHOCYTE RECOVERY

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.