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Klinische Wochenschrift

, Volume 62, Issue 14, pp 675–688 | Cite as

Immunohistological skin alterations in allogeneic bone marrow transplantation

  • C. Müller
  • P. Ostendorf
  • P. Wernet
  • K. Schüch
  • H. Wahl
  • H. D. Waller
Originals

Summary

Skin biopsies of 26 patients with leukemia and seven patients with aplastic anemia were investigated before and at different stages after allogeneic bone marrow transplantation (BMT) to establish the immunological criteria which distinguish skin alterations during normal reconstitution from dermal lesions mediated by graft-versushost disease (GvHD). Of the 33 patients studied 27 presented with clinically diagnosed acute and/or chronic GvHD, one patient died of bone marrow rejection. Immunohistological analysis of the respective skin biopsies with selected monoclonal antibodies against human leukocyte antigens (HLA) and differentiation antigens of the lympho-hematopoietic cells revealed low dermal mononuclear cell counts with phenotypically normal constituents in five cases with uncomplicated reconstitution post-grafting. In contrast, increased dermal cellular infiltrates predominantly consisting of Lyt 3+, OKT 8+ T-lymphocytes, as well as of a large number of Ia-like (immune response associated = HLA-D) determinant+ monocytes/macrophages were observed in all patients with active acute/chronic GvH reactivity. As sign of activation simultaneous expression of HLA-D region products was also found on a subset of the invading OKT 8+ T-lymphocytes. Progression of GvHD was associated with additional surface staining of keratinocytes for Ia-like determinants. Loss of Ia-like determinant+, OKT 6+ dentritic epithelial cells in all leukemic patients, as well as in patients with aplastic anemia with or without GvHD suggested damage of Langerhans cells due to the previous radiotherapy and/or specific immunological destruction. In patients with fatal outcome of GvHD prolonged reduction of these dentritic epithelial cells seemed to be indicative of impaired immune reconstitution or bone marrow dysfunction. Thus immunopathological features of skin GvHR may enable early recognition and prognostic evaluation of this disease possibly allowing more effective therapy.

Key words

Immunohistology Skin alterations Graft-versus-host disease Bone marrow transplantation Langerhans cells 

Abbreviations

GvHD

graft-versus-host disease

GvHR

graft-versus-host reactivity

SAA

severe aplastic anemia

TBI

total body irradiation

BMT

bone marrow transplantation

HLA

human leukocyte antigens

Ia-like antigens

Immune-response-associated antigens

PBS

phosphate buffered saline

FITC

fluorescein isothiocyanate

TRITC

tetramethylrhodamine isothiocyanate

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Copyright information

© Springer-Verlag 1984

Authors and Affiliations

  • C. Müller
    • 1
  • P. Ostendorf
    • 1
  • P. Wernet
    • 1
  • K. Schüch
    • 1
  • H. Wahl
    • 1
  • H. D. Waller
    • 1
  1. 1.Medizinische Klinik Abt. II Universität TübingenGermany

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