10. Cutaneous Chronic Graft-Versus-Host Disease

  1. Bipin N Savani MD
  1. Attilio Olivieri1,
  2. Daniela Massi2,
  3. Andrea Bacigalupo3 and
  4. Anna Campanati1

Published Online: 6 SEP 2013

DOI: 10.1002/9781118473306.ch10

Blood and Marrow Transplantation Long-Term Management: Prevention and Complications

Blood and Marrow Transplantation Long-Term Management: Prevention and Complications

How to Cite

Olivieri, A., Massi, D., Bacigalupo, A. and Campanati, A. (2013) Cutaneous Chronic Graft-Versus-Host Disease, in Blood and Marrow Transplantation Long-Term Management: Prevention and Complications (ed B. N. Savani), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118473306.ch10

Editor Information

  1. Professor of Medicine,Director, Long Term Transplant Clinic, Hematology and Stem Cell Transplantation Section, Vanderbilt University Medical Center, Nashville, TN, USA

Author Information

  1. 1

    Clinica di Ematologia, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy

  2. 2

    Servizio di Anatomia Patologica, Università di Firenze, Florence, Italy

  3. 3

    Divisione di Ematologia e Trapianto di Midollo Osseo, IRCCS AOU San Martino-IST, Genoa, Italy

Publication History

  1. Published Online: 6 SEP 2013
  2. Published Print: 1 OCT 2013

ISBN Information

Print ISBN: 9781118473405

Online ISBN: 9781118473306

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Keywords:

  • cutaneous GVHD;
  • transplantation;
  • chronic GVHD;
  • GVHD treatment

Summary

Cutaneous involvement is the most frequent manifestation of chronic graft-versus-host disease (cGVHD), occurring in about 75% of subjects. It is associated with significant morbidity, functional impairment, poor quality of life, and requires prolonged immune suppressive therapy which increases potentially lethal infectious complications and late effects of transplantation. According to the National Institutes of Health Consensus criteria, some skin manifestations are diagnostic of cGVHD and do not require histopathological confirmation; that is, poikiloderma, lichen-like lesions, morphea-like sclerosis, and deep sclerosis/fasciitis. Risk factors such as the combined use of total body irradiation and unmodified peripheral blood cells suggest that cGvHD is the result of a complex cascade of events, initiating with tissue damage (radiation or high-dose chemotherapy), proceeding with early alloantigen recognition by donor T cells, and culminating in chronic T/B cells activation, production of autoantibodies, and extensive sclerosis of the skin. Once a patient has reached this point, the quality of life is greatly reduced. Early diagnosis, appropriate therapy, and most of all prospective clinical trials are required to better monitor and treat this serious complication.