Early-Onset Lichenoid Graft-Versus-Host Disease: A Unique Variant of Acute Graft-Versus-Host Disease Occuring in Peripheral Blood Stem Cell Transplant Recipients
HJ Votava, CM Magro. New York University School of Medicine, New York, NY; Weill Medical College of Cornell University, New York, NY
Background: Hematopoietic stem cell transplants define an important therapeutic role in the treatment of hematologic malignancies, along with hematologic and immunologic deficiencies. One of the greatest rate limiting factors in its long-term success is chronic graft-versus-host disease (GvHD), a multi-organ process that closely recapitulates autoimmune disease. Although the term chronic GvHD suggests an insidious process developing at least several months after transplantation, there are increasing reports describing its earlier onset.
Design: The purpose of this study was to identify early onset lichenoid GVHD as a potential complication of allogeneic peripheral stem cell transplantation and to determine the origin of the lymphocytic infiltrate present in biopsy specimens of early-onset lichenoid GvHD. A retrospective study identified patients diagnosed with early-onset lichenoid GvHD. An attempt was made to correlate this diagnosis with the nature of the transplant received and concurrent or prior episodes of acute GvHD. The nature of the infiltrating lymphocytes was explored using a fluorescent in situ hybridization (FISH) XY assay.
Results: Patients in whom a sex mismatch was present between donor and recipient were included, representing a study population of 17. All patients had received an allogeneic peripheral blood stem cell transplant (PBSCT). All patients had biopsy proven lichenoid GvHD morphologically indistinguishable from lichenoid chronic graft versus host disease. All patients had prior episodes of acute GvHD, which was biopsy proven in 10 cases. FISH XY studies revealed that the infiltrating lymphocytes were of donor origin in 11 of the cases.
Conclusions: Early-onset lichenoid GvHD is a phenomenon characteristic of PBSCT setting and appears to be mediated by donor lymphocytes reflecting the higher numbers of donor T cells encountered in PBSCT, compared with bone marrow transplant recipients. We consider this reaction pattern a distinctive and unique subtype of acute graft versus host disease.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 70, Tuesday Afternoon