Histologic comparison of autologous graft-vs-host reaction and cutaneous eruption of lymphocyte recovery.
METHODS
The cutaneous eruptions due to allogeneic graft-vs-host disease, autologous graft-vs-host disease, and lymphocyte recovery occur in the setting of peripheral leukocyte reconstitution after marrow aplasia. Since the eruptions of lymphocyte recovery (ELR) and autologous graft-vs-host disease develop in the presence of histocompatibility, 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 autologous marrow transplants or intensive chemotherapy alone for various malignant neoplasms.


RESULTS
In 31% of the cases, we were unable to distinguish 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-vs-host reaction. Satellite cell necrosis was observed in both groups. The patterns of dyskeratotic keratinocytes were similar; one ELR specimen displayed prominent follicular involvement. Most ELR specimens were consistent with grade 1 graft-vs-host reaction changes.


CONCLUSIONS
These findings indicate that the presence of dyskeratotic keratinocytes is not specific for a graft-vs-host reaction and that cutaneous eruptions after autologous marrow transplantation are best considered an ELR.
Bauer
D J
DJ
Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, Md.
Hood
A F
AF
Horn
T D
TD
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D003872:Dermatitis / Q000209:etiology / Q000473:pathology*; D005260:Female; D006087:Graft vs Host Reaction; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*