LICHEN PLANUS-LIKE HISTOPATHOLOGIC CHARACTERISTICS IN THE CUTANEOUS GRAFT-VS-HOST REACTION - PROGNOSTIC-SIGNIFICANCE INDEPENDENT OF TIME-COURSE AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION
Td. Horn et al., LICHEN PLANUS-LIKE HISTOPATHOLOGIC CHARACTERISTICS IN THE CUTANEOUS GRAFT-VS-HOST REACTION - PROGNOSTIC-SIGNIFICANCE INDEPENDENT OF TIME-COURSE AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION, Archives of dermatology, 133(8), 1997, pp. 961-965
Background: 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. Objecti
ves: To identify whether accepted histopathologic criteria of a graft-
vs-host reaction (GVHR) alone or in combination accurately reflect cli
nical phase of disease, to correlate patterns with clinical outcome, a
nd to identify any concordance between inflammation and epidermal chan
ges of a GVHR. Design: Skin biopsy specimens were analyzed according t
o histologically defined standards. Setting: This study was performed
in a tertiary care hospital. Patients: One hundred seventy-three skin
biopsy specimens (10 days before to 1326 days after BMT) from 83 patie
nts undergoing allogeneic BMT for various malignant neoplasms were sel
ected for study. A consecutive 12-month sample was used. Main Outcome
Measures: The main measures in this study were statistical correlation
s between histopathologic findings and time after BMT, the outcome of
BMT, and the correlations between selected histopathologic criteria. R
esults: Fully evolved histologic features of chronic lichenoid GVHR in
the specimens occurred across a nide time range (33-832 days after BM
T) 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 o
ccurred across a wide time range (14-481 days after BMT) and were asso
ciated with a 2.2-fold increased risk for death; this finding was not
statistically significant (P=.11). Inflammation of the upper dermis wa
s significantly associated with acanthosis and epidermal cell necrosis
(P<.001 and P<.001, respectively, for bandlike pattern), confirming t
he importance of this finding as a criterion for the diagnosis of a GV
HR. Blinded evaluation of a subset of specimens for the diagnosis of a
cute vs chronic GVHR resulted in wide interobserver variation. Conclus
ions: This study demonstrates the following: specific histologic param
eters 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-lik
e GVHR is associated with a greater likelihood of death from GVHD; and
identification of upper dermal inflammation correlates with the epide
rmal features of GVHR and should be included in the diagnostic scheme.