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

Massi, Daniela; Fondi, Cristina; Nozzoli, Chiara; Benemei, Silvia; Lapi, Francesco; Albarello, Luca; Avellini, Claudio; Bonoldi, Emanuela; Casini, Marco; Cesinaro, Anna Maria; Ciceri, Fabio; Colombetti, Vito; Comin, Camilla E.; Donelli, Amedea; Fortunato, M.; Fratoni, Stefano; Guidi, Stefano; Messerini, Luca; Milone, Giuseppe; Rapezzi, Davide; Negri, Giovanni; Peccatori, Fedro Alessandro; Ponzoni, Maurilio; Rafaniello, Paola; Raimondi, Roberto; Salomone, Edvige; Tendas, Andrea; Villari, Loredana; Santucci, Marco; Bosi, Alberto

doi:10.1016/j.humpath.2010.07.004

Cited by 9 publications

(9 citation statements)

References 26 publications

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“…Importantly, a single pathological specimen might contain focal areas of varying grade, making definitive grading difficult and probably introducing some element of subjectivity to the final pathological grade assignment in these instances. However, despite well-defined grading schema, histological grade has not been shown to correlate with clinical manifestations of disease 105 . In addition, with the exception of grade 4 histology, which portends a poor prognosis, histological grade is not predictive of treatment response, morbidity or mortality 36,105 .…”

Section: Diagnosismentioning

confidence: 99%

“…However, despite well-defined grading schema, histological grade has not been shown to correlate with clinical manifestations of disease 105 . In addition, with the exception of grade 4 histology, which portends a poor prognosis, histological grade is not predictive of treatment response, morbidity or mortality 36,105 . More so, because of the patchy, diffuse distribution of GVHD, the absence of histological findings should not preclude treatment in the appropriate clinical setting.…”

Section: Diagnosismentioning

confidence: 99%

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Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Naymagon

Wong

et al. 2017

Nat Rev Gastroenterol Hepatol

126

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Haematopoietic stem cell transplantation (HSCT) is central to the management of many haematological disorders. A frequent complication of HSCT is acute graft-versus-host disease (GVHD), a condition in which immune cells from the donor attack healthy recipient tissues. The gastrointestinal system is among the most common sites affected by acute GVHD, and severe manifestations of acute GVHD of the gut portends a poor prognosis in patients after HSCT. Acute GVHD of the gastrointestinal tract presents both diagnostic and therapeutic challenges. Although the clinical manifestations are nonspecific and overlap with those of infection and drug toxicity, diagnosis is ultimately based on clinical criteria. As reliable serum biomarkers have not yet been validated outside of clinical trials, endoscopic and histopathological evaluation continue to be utilized in diagnosis. Once a diagnosis of gastrointestinal acute GVHD is established, therapy with systemic corticosteroids is typically initiated, and non-responders can be treated with a wide range of second-line therapies. In addition to treating the underlying disease, the management of complications including profuse diarrhoea, severe malnutrition and gastrointestinal bleeding is paramount. In this Review, we discuss strategies for the diagnosis and management of acute GVHD of the gastrointestinal tract as they pertain to the practising gastroenterologist.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Naymagon

Wong

et al. 2017

Nat Rev Gastroenterol Hepatol

126

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“…First and foremost, there is no support in the literature for making GVHD treatment decisions based on the histologic grade of acute GVHD, which has been shown to correlate poorly with clinical severity. 8 Suggesting that patients who have histologic grade 1 GI GVHD do not require treatment does not reflect current clinical practice. 9 It may be possible that the authors are confusing histological grading with clinical grading of acute GVHD where it is often standard practice to not intensify therapy for patients with overall clinical grade 1 acute GVHD (o50% skin rash).…”

mentioning

confidence: 99%

Making the diagnosis of gastrointestinal GVHD: is evaluation of the ileum necessary?

Ross

Alousi

2012

Bone Marrow Transplant

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“…14 Contradictory conclusions were drawn by a separate multicenter retrospective study of patients after reduced-intensity conditioning regimens, who reported that histopathologic diagnosis influenced clinical management and correlated with survival, ultimately recommending the continued use of skin biopsies in assessing patients for GVHD. 8 Even when skin biopsies are performed, immunosuppressive therapy may be initiated before histopathologic review is complete, because of the adverse effect of GVHD on patients’ quality of life and survival.…”

Section: Discussionmentioning

confidence: 99%

“…The histopathologic features of acute cutaneous GVHD have been generally described, but not the findings specific to TCD PBSCT recipients. 8 …”

Section: Introductionmentioning

confidence: 99%

Histopathologic Features of Cutaneous Acute Graft-Versus-Host Disease in T-Cell–Depleted Peripheral Blood Stem Cell Transplant Recipients

Fischer

Jakubowski

Lacouture

et al. 2015

The American Journal of Dermatopathology

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T-cell-depleted (TCD) allogeneic hematopoietic stem cell transplantation demonstrates similar efficacy and reduced incidence and severity of graft-versus-host disease (GVHD) in appropriately selected patients versus T-cell-replete transplantation. The histopathology of cutaneous acute GVHD (aGVHD) following TCD peripheral blood stem cell transplants (PBSCT) is not described. We identified 13 cases of patients post TCD-PBSCT, with definitive aGVHD, and 20 cases of non-aGVHD skin rash in patients after TCD-PBSCT, during multidisciplinary review by a dermatopathologist, dermatologist and transplant physician, incorporating clinical presentation, therapeutic response, and histopathology data. Histopathologic features of aGVHD and non-aGVHD skin rash in TCD-PBSCT patients were compared to each other, and also to features recently reported for non-TCD transplant recipients. AGVHD and non-aGVHD skin rash in TCD-PBSCT patients' biopsies had similar rates of epidermal acanthosis, dermal melanophages, neutrophils, plasma cells, eosinophils and extravasated erythrocytes. While satellitosis, exocytosis and adnexal involvement slightly favored aGVHD, more notable differential findings favoring aGVHD, were diffuse (versus focal/absent) basal vacuolization (77% aGVHD vs 25% non-aGVHD rash), involvement of the entire epidermis (versus partial thickness) by necrotic keratinocytes (42% aGVHD vs 0% non aGVHD rash), and non-dense (rather than exuberant) inflammatory infiltrates (77% vs. 20%). After filtering features seen in all TCD samples (epidermal acanthosis, dermal melanophages, neutrophils, plasma cells, eosinophils and extravasated erythrocytes), the most distinct features belonging to aGVHD-positive TCD samples were diffuse basal vacuolization, slight rather than dense inflammatory infiltrates, and necrotic keratinocytes involving the entire epidermis. Awareness of these features may help when evaluating a skin rash occurring after a TCD transplant.

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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

Cited by 9 publications

References 26 publications

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Making the diagnosis of gastrointestinal GVHD: is evaluation of the ileum necessary?

Histopathologic Features of Cutaneous Acute Graft-Versus-Host Disease in T-Cell–Depleted Peripheral Blood Stem Cell Transplant Recipients

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