Early GVHD with Follicular Rash
Van Bekkum and colleagues first described secondary disease following ablation or suppression of a recipients’ immune system followed by lymph-hematopoietic cell transplant from a genetically non-identical donor. The immune reaction by donor T lymphocytes, subsequently known as graft-versus-host disease (GVHD), is preceded by donor T cell activation with secretion of cytokines and expansion of host antigen-presenting cells. The acute form occurring early after transplantation most often presents with a rash ± gastrointestinal symptoms and elevated liver tests. Skin biopsies, in particular, are often first used to establish the diagnosis, but interpretation must consider a number of alternative conditions related to toxicity from pre-transplant conditioning, infectious causes, or reactions to drugs or transfused blood products. The initial site of the skin GVHD attack is against progenitor cell regions in the hair follicle and rete ridges in the epidermis. This chapter discusses the pathobiologic basis for the initial targeting of progenitor regions in skin GVHD, the key histologic findings, and the differential considerations.
KeywordsChronic GVHD Tissue biopsies Biomarkers Follicular GVHD Early GVHD Severe keratinocyte dysplasia
- 12.Shulman H. Pathology of chronic GVHD. In: Burakoff SJ, Deeg HJ, Ferrara J, Atkinson K, editors. Graft-versus-host disease: immunology, pathophysiology and treatment. 1st ed. New York: Marcel Dekker, Inc.; 1990. p. 587–614.Google Scholar