Chronic cutaneous graft-versus-host disease in man

Area of Science:

• Hematology
• Immunology
• Dermatology

Background:

• Allogeneic marrow transplantation can lead to graft-versus-host disease (GVHD), a significant post-transplant complication.
• Chronic GVHD (cGVHD) manifests with diverse clinical features, including prominent cutaneous involvement.

Purpose of the Study:

• To characterize the clinicopathologic features of chronic cutaneous GVHD.
• To propose guidelines for the definition and subclassification of chronic cutaneous GVHD.

Main Methods:

• Clinicopathologic study of 92 patients surviving 150 days or more post-allogeneic marrow transplantation.
• Analysis of cutaneous manifestations, including presentation patterns (de novo, continuation, or after resolution of acute GVHD) and distinct clinical types.

Main Results:

• Chronic cutaneous GVHD affected 19 patients (20.6%).
• Two types were identified: generalized (16 patients) with progressive fibrosis and contractures, resembling morphea and lupus erythematosus; and local (3 patients) with variable sclerosis.
• Ophthalmic-oral sicca syndrome, sialoadenitis, and neurologic findings were also described.

Conclusions:

• Chronic cutaneous GVHD has distinct clinicopathologic presentations and requires standardized classification.
• Proposed guidelines aim to improve the definition and subclassifying of chronic cutaneous GVHD for better management and research.