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 Blood, 1 October 2009, Vol. 114, No. 14, pp. 3113-3116.
Prepublished online as a Blood First Edition Paper on July 30, 2009; DOI 10.1182/blood-2009-03-209635.

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TRANSPLANTATION

Brief report

Impact of macrophage infiltration of skin lesions on survival after allogeneic stem cell transplantation: a clue to refractory graft-versus-host disease

Satoshi Nishiwaki1, Seitaro Terakura1, Masafumi Ito2, Tatsunori Goto1, Aika Seto1, Keisuke Watanabe1, Mayumi Yanagisawa1, Nobuhiko Imahashi1, Shokichi Tsukamoto1, Makoto Shimba1, Yukiyasu Ozawa1, and Koichi Miyamura1

Departments of 1 Hematology and 2 Pathology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

We retrospectively reviewed 104 biopsy specimens of previously untreated skin acute graft-versus-host disease (GVHD) within 100 days after allogeneic stem cell transplantation, and analyzed the relationship between types of infiltrating cells and clinical outcomes. Counting the total number of CD8+ T cells, CD163+ macrophages, and CD1a+ dendritic cells in 4 fields under original magnification x200, the infiltration of more than 200 cells of CD163+ macrophages (many macrophages [MM]) was the only significant predictor for refractory GHVD (odds ratio, 3.79; 95% confidence interval, 1.22-11.8; P = .02). In 46 patients given steroid treatments, MM was the only significant predictor for refractory acute GVHD (odds ratio, 5.05; 95% confidence interval, 1.19-21.3; P = .03). Overall survival of patients with MM was significantly lower than that of those with an infiltration of less than 200 cells of CD163+ macrophages. Macrophage infiltration of skin lesions could be a significant predictive factor for refractory GVHD and a poor prognosis.


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