G D Mahabal1, L George1, D Peter1, M Bindra2, M Thomas2, A Srivastava3, V Mathews3, B George3, S A Pulimood1. 1. Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India. 2. Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India. 3. Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India.
Abstract
BACKGROUND: The skin is the most common organ involved in acute graft-versus-host disease (GvHD). Because histopathology has limited utility in ruling out clinical mimics of acute skin GvHD, more accurate diagnostic techniques are required. AIM: To evaluate the utility of elafin expression in skin by immunohistochemistry (IHC) for accurate diagnosis of acute skin GvHD. METHODS: Consecutive allogeneic haematopoietic stem cell transplant (HSCT) recipients during a 6-month period who developed rash within the first 100 days post-transplant were recruited. Skin biopsies were taken on the day the rash developed. IHC for epidermal elafin was performed and interpreted by a pathologist blinded to the histopathological diagnosis. Staining of ≥ 50% of epidermis was considered positive. Final diagnosis of the rash was assigned using clinical features supported by histopathology. The accuracy of elafin IHC in predicting the final diagnosis of acute GvHD was evaluated. RESULTS: In total, 23 patients (20 male, 3 female; median age 16 years, range 3-53 years) with 27 episodes of skin rash were recruited. Skin rash post-HSCT occurred at a median of 20 days (range 5-45 days). A diagnosis of GvHD was made in 16 episodes (59.26%) while the remaining 11 episodes (40.74%) were judged to be non-GvHD rash. Elafin IHC was positive in all patients with GvHD. Of the 11 episodes of non-GvHD rash, elafin was negative in 8. Thus, the sensitivity and specificity of elafin IHC for predicting acute skin GvHD was 100% and 75%, respectively. CONCLUSION: Tissue elafin is a useful immunohistochemical marker for acute skin GvHD. However, larger studies are needed to validate these results.
BACKGROUND: The skin is the most common organ involved in acute graft-versus-host disease (GvHD). Because histopathology has limited utility in ruling out clinical mimics of acute skin GvHD, more accurate diagnostic techniques are required. AIM: To evaluate the utility of elafin expression in skin by immunohistochemistry (IHC) for accurate diagnosis of acute skin GvHD. METHODS: Consecutive allogeneic haematopoietic stem cell transplant (HSCT) recipients during a 6-month period who developed rash within the first 100 days post-transplant were recruited. Skin biopsies were taken on the day the rash developed. IHC for epidermal elafin was performed and interpreted by a pathologist blinded to the histopathological diagnosis. Staining of ≥ 50% of epidermis was considered positive. Final diagnosis of the rash was assigned using clinical features supported by histopathology. The accuracy of elafin IHC in predicting the final diagnosis of acute GvHD was evaluated. RESULTS: In total, 23 patients (20 male, 3 female; median age 16 years, range 3-53 years) with 27 episodes of skin rash were recruited. Skin rash post-HSCT occurred at a median of 20 days (range 5-45 days). A diagnosis of GvHD was made in 16 episodes (59.26%) while the remaining 11 episodes (40.74%) were judged to be non-GvHD rash. Elafin IHC was positive in all patients with GvHD. Of the 11 episodes of non-GvHD rash, elafin was negative in 8. Thus, the sensitivity and specificity of elafin IHC for predicting acute skin GvHD was 100% and 75%, respectively. CONCLUSION: Tissue elafin is a useful immunohistochemical marker for acute skin GvHD. However, larger studies are needed to validate these results.
Authors: Laura Solán; Diego Carbonell; Paula Muñiz; Nieves Dorado; Elena Landete; María Chicano-Lavilla; Javier Anguita; Jorge Gayoso; Mi Kwon; José Luis Díez-Martín; Carolina Martínez-Laperche; Ismael Buño Journal: Front Immunol Date: 2021-02-19 Impact factor: 7.561
Authors: Makda Getachew Zewde; George Morales; Isha Gandhi; Umut Özbek; Paibel Aguayo-Hiraldo; Francis Ayuk; Janna Baez; Chantiya Chanswangphuwana; Hannah Choe; Zachariah DeFilipp; Aaron Etra; Stephan Grupp; Elizabeth O Hexner; William Hogan; Nora Rebeka Javorniczky; Stelios Kasikis; Carrie L Kitko; Steven Kowalyk; Elisabeth Meedt; Pietro Merli; Ryotaro Nakamura; Muna Qayed; Ran Reshef; Wolf Rösler; Tal Schechter; Daniela Weber; Matthias Wölfl; Gregory Yanik; Rachel Young; John E Levine; James L M Ferrara; Yi-Bin Chen Journal: Transplant Cell Ther Date: 2021-08-30