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Comparative Study
. 2019 Apr 10;24(1):19.
doi: 10.1186/s40001-019-0377-6.

Clinical versus histological grading in the assessment of cutaneous graft versus host disease

M C H Hogenes  1 , L C J Te Boome  2   3 , D C van der Valk  3 , M R van Dijk  4 , R A de Weger  4 , J Kuball  3   5 , P J van Diest  4
Affiliations
Comparative Study

Clinical versus histological grading in the assessment of cutaneous graft versus host disease

M C H Hogenes et al. Eur J Med Res. .

Abstract

Background: Skin biopsies are often used in daily practice for the diagnosis of acute (aGvHD) or chronic graft versus host disease (cGvHD). With the latest understanding in pathogenesis and new National Institute of Health (NIH) classifications for aGvHD and cGvHD, there is a need to evaluate the current prognostic value of histological grading cutaneous GvHD and its correlation to the clinical grade.

Methods: In a retrospective study with 120 skin biopsies (all taken for suspected GvHD) from 110 patients (all classified according to the NIH), biopsies were revised and graded, blinded for clinical information, for either acute of chronic features. Morphological grades were compared for concordance with the clinical grade and survival analyses were done for clinical and histological grading.

Results: Correlation for histologic vs. clinical grading was (very) poor for aGvHD and cGvHD (weighted κ - 0.038 and 0.0009, respectively). Patients with clinical aGvHD had worse prognosis compared to cGvHD. However, at time of biopsy neither clinical nor histological grading predicted the eventual survival for either aGvHD (p = 0.9739 and p = 0.0744, respectively) or cGvHD (p = 0.2149 and p = 0.4465, respectively).

Conclusions: Confirming the diagnosis of GvHD is still a valuable reason for taking a skin biopsy, but this study shows that histologic grading of GvHD in the skin biopsy has no additional value for clinicians in current practice.

Keywords: Grading; Graft versus host disease; Histology; Prognosis; Skin diseases.

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Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE, et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med. 1980;69(2):204–217. doi: 10.1016/0002-9343(80)90380-0. - DOI - PubMed
    1. Schaffer JV. The changing face of graft-versus-host disease. Semin Cutan Med Surg. 2006;25(4):190–200. doi: 10.1016/j.sder.2006.09.001. - DOI - PubMed
    1. Akpek G, Zahurak ML, Piantadosi S, Margolis J, Doherty J, Davidson R, et al. Development of a prognostic model for grading chronic graft-versus-host disease. Blood. 2001;97(5):1219–1226. doi: 10.1182/blood.V97.5.1219. - DOI - PubMed
    1. Horn TD, Zahurak ML, Atkins D, Solomon AR, Vogelsang GB. Lichen planus-like histopathologic characteristics in the cutaneous graft-vs-host reaction. Prognostic significance independent of time course after allogeneic bone marrow transplantation. Arch Dermatol. 1997;133(8):961–965. doi: 10.1001/archderm.1997.03890440027003. - DOI - PubMed
    1. Wingard JR, Piantadosi S, Vogelsang GB, Farmer ER, Jabs DA, Levin LS, et al. Predictors of death from chronic graft-versus-host disease after bone marrow transplantation. Blood. 1989;74(4):1428–1435. - PubMed

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