|
|||||||||
|
|
|
|
|
|
|
|
|
|
|
CORRESPONDENCE We have read with great interest the paper from Daneshpouy
et al,1 regarding the activated eosinophils in the upper
gastrointestinal tract of patients with acute graft-versus-host disease
(GVHD). The authors found that eosinophils were only present
when there were histologic signs of GVHD. In addition, the eosinophil
density correlated with GVHD severity. From those data, the authors
drew the conclusion that tissue eosinophils might thus be a marker of
acute inflammatory flare-ups in GVHD. Furthermore, the authors propose
that systematic duodenal biopsy at the onset of digestive symptoms
should allow early GVHD detection and that pathologic signs of
GVHD, together with eosinophil density, might help to modulate
immunosuppression therapy. The data of our prospective study on the predictive value of bone
marrow eosinophils in the evolution to acute GVHD confirm those
interesting findings. We have performed prospectively bone marrow
smears and histologic evaluation at day +30 and day +100 in 237 patients receiving transplants in our department from July 1997 to
September 2000.2 Ninety-four patients were diagnosed with
acute myelogenous leukemia (AML) or myelodysplasia syndrome (MDS), 68 with chronic myelogenous leukemia (CML), 46 with acute lymphocytic leukemia (ALL), 16 with non-Hodgkin lymphoma (NHL) and
Hodgkin lymphoma, and 13 with nonmalignant hematologic disorders. One
hundred twenty-nine patients (54%) underwent unrelated hematopoietic stem cell transplantation (HSCT), and 108 (46%) patients underwent related HSCT. Twenty patients died before the first bone marrow evaluation at day +30. A significant eosinophilia of more than 7%,
determined at 400 bone marrow cells, was found in 32 patients (15% of
patients). Twenty-eight (87.5%) of those patients developed acute GVHD
grades II to IV (Table 1). Four patients died due to severe GVHD, and 24 patients developed
chronic limited GVHD. We concluded that bone marrow eosinophilia after
HSCT, probably mediated by endogenous interleukin-2, predicts
severe acute GVHD (predictive positive value 87%). But the functional
significance is not known and should be determined.
Few studies have explored the role of eosinophilia in the evolution of acute GVHD. Eosinophilia in HSCT following busulfan-and-cyclophosphamide (Bu+Cy) or total-body-irradiation-and-cyclophosphamide (TBI+Cy) preparative regimens has been regarded by some authors as a valuable indicator of evolution to chronic GVHD.3 But the significance of eosinophilia in acute GVHD is presently unknown. It has been demonstrated4 that blood eosinophils are activated in acute GVHD, and a significant CD25 antigen expression on the eosinophils has been demonstrated. The role of activated eosinophils in the development of cellular tissue destruction in acute GVHD is still a matter of speculation. Daneshpouy et al's paper1 raises a critical issue of the predictive marker of severe-gut GVHD and consequently the early immunosuppressive modulation.
Nadezda Basara, Michael G. Kiehl, and Axel A. Fauser
References
1.
Daneshpouy M, Socie G, Lemann M, Rivet J, Gluckman E, Janin A.
Activated eosinophils in upper gastrointestinal tract of patients with graft-versus-host disease.
Blood.
2002;99:3033-3040 2. Basara N, Schmetzer B, Roemer E, et al. Bone marrow morphologic findings after hematopoietic stem cell transplantation: eosinophilia indicates the evolution to acute graft-versus-host disease. Onkologie. 2000;23(suppl 7):133. 3. Kalaycioglu ME, Bolwell BJ. Eosinophilia after allogeneic bone marrow transplantation using the busulfan and cyclophosphamide preparative regimen. Bone Marrow Transplant. 1994;14:113-115[Medline] [Order article via Infotrieve]. 4. Rumi C, Rutella S, Bonini S, et al. Immunophenotypis profile of peripheral blood eosinophils in acute graft-vs-host disease. Exp Hematol. 1998;26:170-178[Medline] [Order article via Infotrieve].   CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
Related Letter in Blood Online:
Related Article in Blood Online:
This article has been cited by other articles:
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
 |
 |
|||||||
 |
 |
 |
 |
 |
 |
 |
 |
||
| Copyright © 2002 by American Society of Hematology Online ISSN: 1528-0020 | |||||||||
