Atlas of Graft-versus-Host Disease

Foreword
Preface
Contents
Contributors

1: Overview of Hematopoietic Cell Transplantation
Historical Perspective
Indications for Allogeneic Hematopoietic Cell Transplantation
Sources of Hematopoietic Stem Cells
Peripheral Blood Mobilized Stem Cells
Bone Marrow Hematopoietic Stem Cells
Umbilical Cord Blood Stem Cells
Stem Cell Donors
Matched Related Donor
Matched Unrelated Donor
Haploidentical Stem Cell Donors
Conditioning Regimens
Myeloablative Regimens
Reduced-Intensity Conditioning
Graft-Versus-Host Disease Prophylaxis and Treatment
Prophylaxis
Treatment of Acute GVHD
Chronic GVHD
Risk Factors Associated with Chronic GVHD
Treatment of Chronic GVHD
Causes of Treatment Failure
Supportive Care
References

2: Pathophysiology and Immunology of Chronic Graft-Versus-Host Disease
Basic Biology of cGVHD
cGVHD Biomarker
Cellular Biomarkers
T Cells
T-Cell Differentiation Status
CD4 T-Cell Cytokine Subsets (Th1, Th2, Th 17)
Regulatory T Cells (Tregs)
Antigen-Presenting Cells
B Cells and Humoral Immunity
B Cell and B-Cell Activating Factor (BAFF)
Auto-antibodies
Allo-antibodies
Natural Killer (NK) Cells
Inflammatory Cytokine Biomarkers
Genetic Polymorphism
References

3: Clinical Presentation of Acute Cutaneous Graft-Versus-Host Disease
Diagnosing and Staging/Grading Acute GVHD
Clinical Manifestations of Acute GVHD
Erythema
Follicular Accentuation
Morbilliform Lesions
Erythroderma
Reticulated Patterns
Desquamation
Bullae
Papules
References

4: Clinical Presentation of Mucosal Acute and Chronic Graft-Versus-Host Disease
References

5: Histopathology of Cutaneous Graft-­Versus-­Host Disease
Acute Graft-Versus-Host Disease
Concept of Interface Dermatitis
Histologic Grading and Microscopic Findings
Clues to Histologic Diagnosis
Differential Diagnosis of Acute GVHD
Potential Adjunctive Tests
Special Situations
Chronic Graft-Versus-Host-Disease
Main Histologic Patterns in cGVHD: Lichenoid and Sclerodermoid
Unique Histologic Features of cGVHD
Psoriasiform Pattern
Eczematous Pattern
Lupus-like Pattern
Pityriasis Rosea–like Pattern
Comedone-like Pattern
Follicular Keratosis or Keratosis Pilaris–like Pattern
cGVHD-associated Angiomatosis
Differential Diagnosis of cGVHD
References

6: Grading and Treatment of Acute Graft-­Versus-­Host Disease
Diagnosis and Grading of aGVHD
Physiology Overview
Diagnosis
Differential Diagnosis
Drug Hypersensitivity
Toxic Erythema of Chemotherapy
Engraftment Syndrome
Grading and Prognostication
Treatment of aGVHD
Brief Note on the Prevention of aGVHD
Treatment of Grade I aGVHD
Grade II or Greater aGVHD
Corticosteroid-Refractory aGVHD
Extracorporeal Photopheresis
Anti-CD26 Antibody
Rabbit Antithymocyte Globulin
References

7: Clinical Presentation of Nonsclerotic Epidermal Chronic Graft-Versus-Host Disease and Hair and
Diagnosing and Scoring Chronic GVHD
Clinical Manifestations of cGVHD
Diagnostic Features
Lichen Planus–like GVHD
Lichen Sclerosus–like GVHD
Poikiloderma
Distinctive Features
Papulosquamous Eruptions
Depigmentation
Additional Manifestations
Other Morphologies
Hair (Alopecia)
Nail Changes
References

8: Dermal and Subcutaneous Chronic Graft-Versus-Host Disease
Clinical Presentation
Superficial Dermis: Lichen Sclerosus Type
Deep Dermis: Morpheaform Type
Subcutaneous Fat (Panniculitic) cGVHD
Fascial cGVHD
Prognosis
Treatment
Scoring Systems to Determine the Effect of Treatment
Skin-Directed Therapeutics
Topical Corticosteroids, Vitamin D Analogues, Calcineurin Inhibitors
Phototherapy
Narrow-Band UVB
Photochemotherapy/PUVA
UVA1
Non–skin-directed Systemic Therapeutics
Conventional Immunosuppression, Corticosteroids, Steroid-Sparing Immunosuppressants, Calcineurin In
Extracorporeal Photopheresis
Rituximab
Imatinib
Ruxolitinib
Low-Dose Interleukin-2
Ibrutinib
Pathology
Histopathology
Immunophenotype and Molecular Findings
Differential Diagnosis
Lichen Sclerosus, Morphea, Systemic Sclerosis, Lupus Panniculitis, Eosinophilic Fasciitis
Nephrogenic Systemic Fibrosis
Toxic Oil Syndromes
Vascular Tumors
References

9: Pediatric Graft-Versus-Host Disease
Acute Graft-Versus-Host Disease in Pediatric Patients
Introduction to Acute GVHD
Incidence of Acute GVHD
Risk Factors for Acute GVHD
Clinical Features of Acute GVHD
Differential Diagnosis for Acute GVHD
Histopathology and Laboratory Evaluation of Acute GVHD
Classification of Acute GVHD
Treatment of Acute GVHD
Outcomes of Acute GVHD
Chronic Graft-Versus-Host Disease in Pediatric Patients
Introduction to Chronic GVHD
Incidence of Chronic GVHD
Risk Factors for Chronic GVHD
Clinical Features of Chronic GVHD
Differential Diagnosis for Chronic GVHD
Histopathology and Laboratory Evaluation of Chronic GVHD
Treatment of Chronic GVHD
Outcomes of Chronic GVHD
References

10: Diagnosis, Staging, and Treatment of Chronic Graft-Versus-Host Disease
Diagnosis and Staging
Treatment
Treatment of Mild Cutaneous cGVHD
Treatment of Moderate and Severe Cutaneous cGVHD
Rituximab
Extracorporeal Photopheresis
Phototherapy
Imatinib Mesylate
Mammalian Target of Rapamycin (mTOR) Inhibitors
Low-Dose Interleukin (IL)-2
Janus Kinase (JAK) Inhibitors
Prophylaxis
References

11: Wound Care in the Management of Chronic Graft-Versus-Host Disease
Introduction
Cleaning and Compression
Cleaning
Compression
Topical and Intralesional Steroids
Topical Steroids
Intralesional Steroids
Topical Calcineurin Inhibitors
Complex Wounds
Collagen Gel and Matrix
Silver Dressings
Maggot Debridement Therapy
Summary
References

12: Atypical Manifestations of Graft-Versus-­Host Disease
Eczematous Eruptions
Papulosquamous Eruptions
Reactive Erythema
Erythroderma and Exfoliative Dermatitis
Ichthyosiform GVHD
Extensive Follicular Eruptions in GVHD
Atypical Acral Lesions in GVHD
GVHD-Associated Angiomatosis
GVHD-Mimicking Connective Tissue Diseases
Unusual Distributions of GVHD
Atypical Oral Manifestations
Unusual Sequelae of Cutaneous GVHD
Summary
References
Index