Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Study Letter
ARTICLE IN PRESS
doi:
10.25259/IJDVL_842_2023

Risk factors associated with chronic cutaneous graft-versus-host disease: A retrospective study

Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Quanshan, Xuzhou, Jiangsu, China.

Corresponding author: Dr. Guan Jiang, Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, Quanshan, Xuzhou, Jiangsu, China. dr.guanjiang@xzhmu.edu.cn

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Tang H, Guo S, Zhang Y, Xia J, Jiang G. Risk factors associated with chronic cutaneous graft-versus-host disease: A retrospective study. Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_842_2023

Dear Editor,

Chronic graft-versus-host disease (CGVHD) can affect many parts of the body, with cutaneous manifestations being the most common.1 The aim of this study was to investigate the clinical features of chronic cutaneous graft-versus-host disease (CCGVHD) following allogeneic hematopoietic stem cell transplantation and the risk factors for its development.

Clinical data were collected from 39 patients who developed CCGVHD after allogeneic hematopoietic stem cell transplantation at our hospital from January 2018 to October 2022. A control group of 39 patients with CGVHD without cutaneous manifestations who visited the clinic during the same period were also selected. Clinical data such as age, sex, donor–recipient relationship, human leukocyte antigen (HLA) compatibility, history of acute graft-versus-host disease (AGVHD), and time of onset of CCGVHD after transplantation were collected and statistically analysed. In the observation group, there are 19 males and 20 females, aged (32.28±14.93) years. The primary diseases included 16 cases of acute myeloid leukaemia (AML), 9 cases of acute lymphoblastic leukaemia (ALL), 1 case of chronic myeloid leukaemia (CML), 7 cases of myelodysplastic syndrome (MDS), 3 cases of aplastic anaemia (AA), 1 case of primary myelofibrosis (PMF), and 2 cases of lymphoma. The donor-recipient relationships were all within the second generation of blood relatives (father, mother, siblings). The donors and recipients were HLA-haploidentical in 28 cases and HLA- identical in 11 cases. There were 21 cases with a history of acute GVHD.

The onset of cutaneous cGVHD was 7.00 (4.00, 10.25) months after transplantation, 17 cases developed within six months after transplantation, 16 cases developed between 0.5 and 1 year, 5 cases developed between 1 and 2 years, and 1 case developed after 2 years. For medication before the onset of cGVHD, 16 cases had stopped all anti-rejection drugs before the onset of disease, 22 cases were applied glucocorticoids, all systematically (dose equivalent to prednisone, 20 mg/d ∼ 120 mg/d), 14 cases were using cyclosporine (50 mg/d ∼ 175 mg/d), 14 cases were using a combination of glucocorticosteroids and cyclosporine; 7 cases were additionally treated with ruxolitinib. Compared with the control group, the observation group had a higher HLA compatibility [(28/39, 71.8%) vs (13/39, 33.3%)] and a lower proportion of patients with no previous AGVHD [(17/39, 43.6%) vs (30/39, 76.9%)]. There were no significant differences between the two groups with regard to age, gender, type of primary disease, and donor–recipient sex ratio. In the observation group, there were 14 cases of lichenoid lesions, nine cases of eczematous lesions, and nine cases of sclerodermatous manifestations [Figures 1a-1d, 2a-2b, and 3a-3b]. None of them showed Raynaud’s phenomenon and the manifestations were predominantly located on the trunk, extremities, head, and neck. Logistic regression analysis indicated that neither previous AGVHD (p = 0.095, OR = 2.337, 95%CI 0.864-6.322) nor HLA compatibility (p = 0.102, OR = 0.453, 95%CI 0.176-1.170) was an independent risk factor for the development of CCGVHD. These results suggest that there is no significant association between HLA compatibility or history of AGVHD and the occurrence of CCGVHD in this study cohort.

(a, b) Lichenoid chronic cutaneous GVHD with multiple hyperpigmented scaly patches on the trunk, (c) Multiple hyperpigmented scaly patches on the upper limb, (d) Erythematous scaly plaques on palm.
Figure 1:
(a, b) Lichenoid chronic cutaneous GVHD with multiple hyperpigmented scaly patches on the trunk, (c) Multiple hyperpigmented scaly patches on the upper limb, (d) Erythematous scaly plaques on palm.
Lichenoid chronic cutaneous lesions with dark brown patches around the nails of both hands.
Figure 2a:
Lichenoid chronic cutaneous lesions with dark brown patches around the nails of both hands.
Lichenoid chronic cutaneous lesions with diffuse hyperpigmented plaques and desquamation on both palms.
Figure 2b:
Lichenoid chronic cutaneous lesions with diffuse hyperpigmented plaques and desquamation on both palms.
Scleroderma-like chronic cutaneous lesions with multiple sclerotic plaques and pigmentation changes on the trunk.
Figure 3a:
Scleroderma-like chronic cutaneous lesions with multiple sclerotic plaques and pigmentation changes on the trunk.
Scleroderma-like chronic cutaneous lesions with multiple sclerotic plaques and pigmentation changes on the upper limb.
Figure 3b:
Scleroderma-like chronic cutaneous lesions with multiple sclerotic plaques and pigmentation changes on the upper limb.

One patient with vasculitic CCGVHD underwent a histopathologic examination of the skin. Microscopic analysis revealed focal and mild hyperplasia of the epidermis, with small blood vessels in the superficial and middle layers of the dermis were infiltrated by a high number of lymphocytes and eosinophils [Figure 4].

Focal mild hyperplasia of the epidermis is observed, with a high infiltration of lymphocytes and eosinophils in the small blood vessels of the superficial dermis. Haematoxylin and eosin, 100x).
Figure 4:
Focal mild hyperplasia of the epidermis is observed, with a high infiltration of lymphocytes and eosinophils in the small blood vessels of the superficial dermis. Haematoxylin and eosin, 100x).

In addition to the HLA matching and history of prior AGVHD, which were examined in this study, the literature reports several other risk factors for CGVHD, including donor–recipient age, gender, donor parity, graft source, intensity of conditioning regimen, etc.2-5 Arora et al. found through multivariate Cox regression analysis that AGVHD grade III–IV, peripheral blood stem cell transplantation and HLA mismatch were independent risk factors for CGVHD6. Loren et al. showed that female donors with a history of pregnancy increased the risk of CGVHD in all recipients7. Moreover, older age, intensive conditioning regimens, and the use of total body irradiation were also considered risk factors for CGVHD7.

Our study suggests that factors such as age and gender may not be significantly associated with the occurrence of CCGVHD, which contradicts some literature reports. We further performed a logistic regression analysis of factors such as HLA matching degree and history of prior AGVHD, and the results showed that neither of them was an independent risk factor for the development of CCGVHD. This finding differs from the study by Arora et al6.

The reasons for the above differences may include the following factors: first, this study is a retrospective analysis with a relatively small sample size and insufficient statistical power; second, this study lacks complete information, such as donor parity, and could not conduct a more comprehensive analysis of these factors; third, variations in the definition and diagnostic criteria of CGVHD across different studies may affect the comparability of risk factor analysis results.

This retrospective study examined the clinical features and risk factors of CCGVHD in 39 patients following allogeneic hematopoietic stem cell transplantation. Our findings revealed that CCGVHD manifests with diverse clinical presentations, predominantly as lichenoid, eczematous, and sclerodermatous changes, with a median onset time of seven months post-transplantation. Although differences in HLA compatibility and history of AGVHD were observed between patients with and without CCGVHD, these factors did not reach statistical significance as independent risk factors. This study provides valuable insights into the clinical characteristics of CCGVHD, which may aid in early recognition and diagnosis. However, the limited sample size and retrospective nature of this study underscore the need for larger, prospective investigations to further elucidate the risk factors and pathogenesis of CCGVHD, ultimately guiding improved prevention and treatment strategies.

Ethical approval

The studies involving human participants were reviewed and approved by the Ethics Committee of Xuzhou Medical University Affiliated Hospital, with the ethical approval number XYFY-KL424-01 dated November 17, 2022.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

References

  1. , . Cutaneous graft-versus-host disease. Arch Dermatol. 1998;134:602-12.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , , , , et al. Chronic GVHD risk score: A center for international blood and marrow transplant research analysis. Blood. 2011;117:6714-20.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  3. , , , , , , et al. Impact of donor and recipient sex and parity on outcomes of HLA-identical sibling allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2006;12:758-69.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , , , et al. Comparative analysis of risk factors for acute graft-versus-host disease and for chronic graft-versus-host disease according to National Institutes of Health consensus criteria. Blood. 2011;117:3214-49.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  5. , , , , , , et al. Risk factors for acute GVHD and survival after hematopoietic cell transplantation. Blood. 2012;119:296-307.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  6. , , , , , , et al. Chronic GVHD risk score: a Center for International Blood and Marrow Transplant Research analysis. Blood.. 2011;117:6714-20.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  7. , , , , , , et al. Impact of donor and recipient sex and parity on outcomes of HLA-identical sibling allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant.. 2006;12:758-69.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
2,379

PDF downloads
154
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections