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Graft-versus-Host-Disease der Haut

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Zusammenfassung

Obwohl es heute möglich ist, Patienten mit Leukämie oder anderen hämatologischen Neoplasien durch eine Stammzelltransplantation zu heilen, ist eine hohe Rate an Komplikationen und eine daraus resultierende transplantationsassoziierte Letalität von etwa 30% zu erwarten. Diese Komplikationen sind eng mit der immunologischen Hauptreaktion, der Graft-versus-Host-Reaktion (GvHD), verknüpft. Man unterscheidet eine akute und eine chronische GvHD und definiert sie bisher nach dem Zeitpunkt ihres Auftretens. Die akute GvHD tritt meist innerhalb von 100 Tagen nach der Transplantation auf und findet sich bei bis zu 50% der Transplantierten. Die chronische GvHD manifestiert sich meist zwischen dem 100. und 500. Tag bei etwa 30–50% der allogen Transplantierten. Sie kann die Haut lokalisiert oder disseminiert betreffen. Neben der Haut werden dabei besonders die Leber, der Gastrointestinaltrakt, seltener auch die Lunge, die Augen und der neuromuskuläre Apparat betroffen. Häufig bereitet die Diagnose einer GvHD zu Beginn differenzialdiagnostische Schwierigkeiten, da Arzneimittelreaktionen, Virusexantheme oder Hautveränderungen nach Chemo- oder Strahlentherapie klinische und histologische Ähnlichkeiten aufweisen können. Im Folgenden werden die verschiedenartigen Hauterscheinungen, die im Zusammenhang mit einer GvHD auftreten können, das histopathologische Bild sowie Prophylaxe und Therapie der akuten sowie der chronischen GvHD anhand der aktuellen Literatur besprochen.

Abstract

Although stem cell transplantation is a life-saving measure and the treatment of choice for many patients with various hematologic malignancies, a high incidence of complications and a transplantation associated mortality of about 30% are to be expected. Graft-versus-Host Disease (GvHD) is the major cause of morbidity and mortality after stem cell transplantation. GvHD can arise at various time points. Acute GvHD occurs during the first 100 days after transplantation in up to 50% of graft recipients, while chronic GvHD develops in about 30–50% usually within 100–500 days following allogeneic stem cell transplantation. It can involve the skin, liver, gastrointestinal tract, and less frequently the lungs, eyes and neuromuscular system. Early diagnosis of GvHD can be difficult, as drug reactions, viral infections and cutaneous reactions to radiation therapy may have clinical and histological similarities. In this review, the various cutaneous manifestations of GvHD, the histopathologic features, prophylaxis and therapy of acute and chronic GvHD are discussed in light of the recent literature.

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  1. Klinik und Poliklinik für Dermatologie, Universität Regensburg

    S. Karrer

  2. Klinik und Poliklinik für Dermatologie, Universität Regensburg, Franz-Josef-Strauss-Allee 11, 93042 , Regensburg

    S. Karrer

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Karrer, S. Graft-versus-Host-Disease der Haut. Hautarzt 54, 465–482 (2003). https://doi.org/10.1007/s00105-003-0528-z

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  • DOI: https://doi.org/10.1007/s00105-003-0528-z

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