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Lymphoma - Non B cell neoplasms

Post-transplantation lymphoproliferative disorders

Graft versus Host Disease


Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 30 October 2011, last major update September 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

Clinical description
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● Common complication of allogeneic bone marrow transplantation seen in 20-50% of HLA identical and 70% of nonidentical / unrelated recipients
● Causes 1/3 of bone marrow transplant deaths

Acute GVHD: within 100 days of transplant; affects skin, GI tract, liver
● Skin maculopapular rash of palms, soles, trunk, later entire body; may progress to bullous patches and desquamation
● GI diarrhea (profuse, bloody), nausea, abdominal pain
● Liver elevated liver function tests, nausea, vomiting
● Also oral GVHD with xerostomia

Chronic GVHD: after 200 days of transplant; autoimmune-like symptoms, wasting, recurrent infections, prolonged immunodeficiency

Pathophysiology
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● Due to donor T cytotoxic (CD8+) T cells introduced with bone marrow cells as bystanders that attack recipient tissue
● Donor T cells recognize host HLA antigens, proliferate and secrete Interleukin-2 and then other cytokines including tumor necrosis factor, IL-1 and interferon, causing tissue damage

Treatment
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● Increased immunosuppression, irradiation (treatment opposite that of post-transplant lymphoproliferative disease)

Micro description
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Skin: Lerner et al, Transplant Proc 1974;6:367
Grade 1: vacuolar degeneration of basal epithelial cells or acanthocytes
Grade 2: also dyskeratosis, apoptosis of keratinocytes (eosinophilic bodies) surrounded by lymphocytes, spongiosis, edema of overlying epithelium
Grade 3: also splitting and degeneration of acanthocytes and basal cells, causing cleft formation and separation of dermoepidermal junction
Grade 4: sloughing of overlying epithelium

Rectum:
Early: flatting/atrophy of mucosa, degeneration and loss of crypts; occasional apoptotic bodies surrounded by lymphocytes
Late: mucosal sloughing

Salivary glands:
Grade 1: abnormal mononuclear infiltrates with or without ductal epithelial necrosis
Grade 2: also obliteration of ducts

Differential diagnosis
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● Chemotherapy effect, drug reaction, infection

End of Lymphoma - Non B cell neoplasms > Post-transplantation lymphoproliferative disorders > Graft versus Host Disease


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