Lack of specificity in skin biopsy specimens to assess for acute graft-versus-host disease in initial 3 weeks after bone-marrow transplantation.

Acute graft-versus-host disease is a serious and common complication after allogeneic bone-marrow transplantation, occurring in more than 20% of HLA antigen-identical sibling transplants and unrelated donor transplants. Bone-marrow transplantation is considered standard therapy for several hematologic malignancies and several nonhematologic disorders. In this retrospective study, we searched our institutional dermatopathology database between January 1998 and November 2002 for patients in whom skin biopsy specimens were examined less than 3 weeks after bone-marrow transplantation. A total of 40 slides from 38 patients were examined for the presence of the histologic features characteristic of acute graft-versus-host disease. Specimens of skin biopsies examined in the study varied from 3 to 21 days, with a mean of 12 days, status post-bone-marrow transplantation. The histologic findings of the 40 slides we examined were nonspecific and could be accounted for by a number of diagnoses. In summary, we propose that skin biopsies need not be preformed before 3 weeks status post-bone-marrow transplantation if the sole purpose is to rule out acute graft-versus-host disease.