Immunohistology of skin and oral biopsies in graft-versus-host disease after bone marrow transplantation and cytokine therapy.
BACKGROUND
Early diagnosis of graft-versus-host-disease (GVHD) after bone marrow transplantation is often difficult, particularly when the patients are immunosuppressed by chemotherapy or irradiation.


OBJECTIVE
To investigate the influence of cytokines on skin lesions after bone marrow transplantation.


METHODS
Biopsy specimens of skin and oral mucosa were obtained from bone marrow transplant patients with GVHD and were subjected to histologic and immunohistochemical examination.


RESULTS
Administration of granulocyte-macrophage colony-stimulating factor caused atopic dermatitis-like lesions in two patients, who had infiltration of neutrophils, eosinophils, and lymphocytes around the hair follicles of the skin and no signs of GVHD in other organs. Only patients who were treated with cytokines developed acute GVHD. Immunohistochemical examination of skin biopsies from 18 patients with acute GVHD and 11 patients with chronic GVHD after cyclophosphamide administration or irradiation showed that the maculopapular skin lesions characteristic of acute GVHD contained infiltrates of CD4+ and CD8+ lymphocytes. There was also an increase in numbers of epidermal keratinocytes expressing intercellular adhesion molecule-I and HLA-DR antigens.


CONCLUSIONS
These findings support the involvement of cytokines in GVHD and suggest that immunostaining of skin biopsies may be useful for the early diagnosis of this condition.
Yamada
H
H
Department of Dermatology, Kinki University Hospital, Osaka, Japan.
Chihara
J
J
Hamada
K
K
Matsukura
M
M
Yudate
T
T
Maeda
K
K
Tubaki
K
K
Tezuka
T
T
D000208:Acute Disease; D001706:Biopsy; D016026:Bone Marrow Transplantation / Q000276:immunology; D002908:Chronic Disease; D016207:Cytokines / Q000627:therapeutic use*; D004817:Epidermis / Q000276:immunology*; D006086:Graft vs Host Disease / Q000276:immunology*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D015603:Keratinocytes / Q000276:immunology; D016173:Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D009061:Mouth Mucosa / Q000276:immunology*
D016207:Cytokines; D016179:Granulocyte Colony-Stimulating Factor; D016173:Macrophage Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor