Partial reconstitution of cutaneous microvessels in long-term survivors after allogeneic bone marrow transplantation.
BACKGROUND
Graft-versus-host disease (GVHD) is a major complication after allogeneic hematopoietic stem cell transplantation (HSCT) and skin is involved in acute and chronic disease. Immune-mediated vessel attack and subsequent microvessel loss have been observed in skin of patients with chronic GVHD.


OBJECTIVE
To test whether long-term survivors (LTS) after allogeneic HSCT without cutaneous GVHD show signs of persistent vascular remodeling.


METHODS
Microvessels in skin biopsies were investigated in a cohort of 32 LTS with a median follow-up of 17 years (range 11-26). Five were currently classified as having chronic GVHD other than skin involvement.


RESULTS
LTS showed no significant difference in median microvessel density and relative vessel size distribution pattern compared to healthy controls. Past experience of GVHD and current status of chronic GVHD other than skin involvement had no impact on vessel density. In contrast, recipients with chronic cutaneous GVHD of sclerotic type and patients with lichen sclerosus have significant microvessel loss in the upper dermis.


CONCLUSIONS
The complex therapy of allogeneic HSCT had no sustained effect on the microvascular architecture of LTS when clinicopathological evidence of cutaneous GVHD is absent. Microvascular remodeling as observed during chronic GVHD recovers completely after resolution of chronic cutaneous GVHD.
Haeusermann
P
P
Department of Dermatology, University Hospital Basel, Basel, Switzerland. phaeusermann@uhbs.ch
Kump
E
E
Rovó
A
A
Tichelli
A
A
Itin
P
P
Gratwohl
A
A
Biedermann
B C
BC
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007150:Immunohistochemistry; D018459:Lichen Sclerosus et Atrophicus / Q000473:pathology; D008297:Male; D055806:Microvessels / Q000737:chemistry / Q000473:pathology*; D008875:Middle Aged; D012594:Scleroderma, Localized / Q000473:pathology; D012867:Skin / Q000098:blood supply*; D012871:Skin Diseases / Q000209:etiology / Q000473:pathology; D055815:Young Adult; D014841:von Willebrand Factor / Q000032:analysis
D014841:von Willebrand Factor