Eruptive angiomatous lesions associated with graft-versus-host disease

Endothelial chimerism in chronic sclerotic-type chronic graft-versus-host disease (GVHD) and GVHD-associated angiomatosis

“…During allogeneic transplantation, donor haematopoietic stem cells are selected for by CD34 + surface marker expression. Long‐standing sclerosis in the context of cGVHD coupled with elevated endothelial growth factors may allow these persistent donor cells to proliferate, resulting in GVHD‐AA . Consistently, as the duration post‐transplant increases, endothelial proliferation leads to expansion of donor‐derived endothelial cells regardless of GVHD status …”

Graft-versus-host disease-associated angiomatosis: A clinicopathologically distinct entity

“…19 Elevated levels of vascular endothelial growth factor and β-fibroblastic growth factor have also been reported in the affected skin of a patient with GVHD-associated eruptive vascular lesions. 4 These cytokines may stimulate donor derived CD34+, KDR+ endothelial progenitors to proliferate. The endothelial progenitor cells are selected for transplantation in addition to hematopoietic stem cells due to expression of CD34 in addition to the common locations in the peripheral blood and bone marrow.…”

“…Thalidomide, despite its anti-angiogenic properties, was ineffective in three previously reported patients. 4,5,8 External-beam radiation therapy provided temporary benefit in one previous patient. 5 Radiation therapy may be challenging for patients with extensive disease, and may predispose to non-healing wounds when used on the lower extremity.…”

“…An uncommon cutaneous presentation of cGVHD is “eruptive angiomas,” a manifestation that is rarely reported, poorly understood, and challenging to treat. 4–8 In this study, we characterize the clinical and histopathologic presentation of GVHD-associated endothelial proliferations in 11 patients and propose the term GVHD-associated angiomatosis (GVHD-AA).…”

Graft-versus-host disease

“…Benign vascular tumors can develop on severely sclerotic skin [41][42][43] (Fig 4) and may require a biopsy specimen to rule out malignancy. Epidermodysplasia verucciformis (EV)elike lesions associated with human papillomavirus types 8 and 20 have been reported in the setting of GVHD and are linked to other EV-related haplotypes.…”