The impact of histopathologic examination of graft-versus-host disease in the era of reduced-intensity conditioning regimen: a study from the Gruppo Italiano Trapianto di Midollo Osseo
The impact of histopathologic examination of graft-versus-host disease in the era of reduced-intensity conditioning regimen: a study from the Gruppo Italiano Trapianto di Midollo Osseo
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DOI：
10.1016/j.humpath.2010.07.004
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发表时间：
2011-02-01
期刊：
影响因子：
3.3
通讯作者：
Bosi, Alberto
中科院分区：
文献类型：
--
作者：
Massi, Daniela;Fondi, Cristina;Bosi, Alberto
降低强度的预适应方案重塑了造血干细胞移植后移植物抗宿主病的临床表现。然而，低强度预适应方案后移植物抗宿主病的组织病理学特征尚未完全确定。在112例活组织检查中(皮肤，n=60；胃肠道，n=44；肝脏，n=8)，我们描述了低强度预适应后移植物抗宿主病的形态特征，并调查了低强度预适应后移植物抗宿主病的组织病理学变化是否具有诊断和/或预后价值。急性移植物抗宿主病44例(49.5%)，迟发性急性移植物抗宿主病2例(2.2%)(I级13例，II-IV级33例)，慢性移植物抗宿主病24例(27.0%)，新发12例，进展性12例，重叠综合征19例(21.3%)。在皮肤中，我们观察到：(I)非特异性时相性变化，如慢性移植物抗宿主病患者的急性移植物抗宿主病特征(n=4/24；16.6%)，(Ii)细微变化，如增宽的真皮乳头浅层纤维化(n=8)，急性移植物抗宿主病/晚发型移植物抗宿主病(n=6/46；慢性移植物抗宿主病(n=2/24，8.3%)或慢性移植物抗宿主病(n=2/24，8.3%)；(3)重叠综合征(n=3/19；15.7%)。在胃肠道，我们没有表现出与清髓环境中常见的特征不同的特殊特征。单变量分析显示，移植物抗宿主病类型(慢性移植物抗宿主病P=.006，急性移植物抗宿主病P=0.03)、高龄(P=0.04)以及组织病理学诊断为“符合”+明确移植物抗宿主病(P=0.02)与总存活率降低有关。经多因素分析，组织病理学诊断仍具有独立的预后价值(P=.01)。本研究表明，病理学家应该意识到低强度预适应后皮肤移植物抗宿主病的特殊形态变化，并进一步建议在接受低强度预适应方案的患者中，组织病理学用于移植物抗宿主病的诊断工作。(C)2011 Elsevier Inc.保留所有权利。
Reduced-intensity conditioning regimens have reshaped the clinical presentation of graft-versus-host disease after hematopoietic stem cell transplants. However, histopathologic features of graft-versus-host disease following reduced-intensity conditioning regimens have not been fully characterized. In a series of 112 biopsies (skin, n = 60; gastrointestinal [GI] tract, n = 44; liver, n = 8), we described the morphologic profile of graft-versus-host disease following reduced-intensity conditioning and investigated whether histopathologic changes of graft-versus-host disease following reduced-intensity conditioning have a diagnostic and/or prognostic value. Forty-four patients (49.5%) experienced acute graft-versus-host disease, 2(2.2%) late-onset acute graft-versus-host disease (grade I, n = 13; grade II-IV, n = 33), 24(27.0%) chronic graft-versus-host disease (de novo n = 12, progressive n = 12) and 19 (21.3%) overlap syndrome. In the skin, we observed: (i) phase-nonspecific changes, such as acute graft-versus-host disease features in chronic graft-versus-host disease patients (n = 4/24; 16.6%), (ii) subtle alterations such as superficial fibrosis in widened dermal papillae (n = 8), in acute graft-versus-host disease/late-onset graft-versus-host disease (n = 6/46; 13.0%) or chronic graft-versus-host disease (n = 2/24, 8.3%) patients, and (iii) features of chronic and acute graft-versus-host disease coexisting in the same specimen in overlap syndrome (n = 3/19; 15.7%). In the GI tract, we did not demonstrate peculiar features differing from those commonly observed in the myeloablative setting. By univariate analysis, a reduced overall survival was associated with graft-versus-host disease type (chronic graft-versus-host disease P = .006, acute graft-versus-host disease P = .03), older age (P = .04), and histopathologic diagnosis of "consistent with" + definite graft-versus-host disease (P = .02). Histopathologic diagnosis retained an independent prognostic value by multivariate analysis (P = .01). The present study indicates that pathologists should be aware of the peculiar morphologic changes of cutaneous graft-versus-host disease following reduced-intensity conditioning and further recommends histopathology in the diagnostic workup of graft-versus-host disease in patients undergoing reduced-intensity conditioning regimen. (C) 2011 Elsevier Inc. All rights reserved.