Blood, 1 March 2003, Vol. 101, No. 5, pp. 2073-2073
CORRESPONDENCE
To the editor:
Eosinophils and severe forms of graft-versus-host
disease
Basara et al1 recently reported interesting data on
the predictive value of eosinophilia in the evolution to acute
graft-versus-host disease (GVHD) in a systematic prospective study of
bone marrow smears and biopsies (n = 237). This is in accordance with
our previous findings in patients with upper gastrointestinal tract GVHD. In a series of 93 patients, eosinophils were present only when
there were histologic signs of GVHD and eosinophil density correlated
with GVHD severity.2 Since few data are available on
eosinophils and GVHD, it is therefore important to have a validation of
similar results by 2 independent teams on 2 different organs in
patients with GVHD.
The fact that eosinophils show signs of activation both in
blood3 and target organs2,4 of patients with
acute flares of GVHD raises the question of their deleterious effect on
target organs in GVHD. Signs of eosinophil activation, both in blood and target organs, were also found in patients with severe eosinophilic syndromes.5 Experimental studies to assess the role of
eosinophils in target organ damage cannot be performed in humans for
ethical reasons. However, there is an increasing amount of
clinicopathologic data that links eosinophils to severity of target
organ damage. To remain in the field of GVHD, eosinophils are linked to
severe forms of GVHD when detected in bone marrow, gut, and
conjunctiva, but they are also associated with a striking resistance to
conventional therapy in fasciitis. This rare form of GVHD6
shares many clinicopathologic features with eosinophilic
fasciitis7 except for the dramatic response to steroid therapy.
Therefore, systematic study of eosinophils in biopsies of patients with
GVHD could contribute to assess GVHD severity and thus may help to
modulate immunosuppression therapy.
Anne Janin, Marjan Ertault-Daneshpouy, and Gérard Socié
Correspondence: Anne Janin, Service de
Pathologie, Hôpital Saint Louis, 1 avenue Claude Vellefaux
75475 Paris Cedex 10, France; e-mail:
anne_janin{at}yahoo.com
References
1.
Basara N, Kiehl MG, Fauser AA.
Eosinophilia indicates the evolution to acute graft-versus-host disease [letter].
Blood.
2002;100:3055[Free Full Text].
2.
Daneshpouy M, Socie G, Lemann M, et al.
Activated eosinophils in upper gastrointestinal tract of patients with graft-versus-host disease.
Blood.
2002;99:3033-3040[Abstract/Free Full Text].
3.
Rumi C, Rutella S, Bonini S, et al.
Immunophenotypic profile of peripheral blood eosinophils in acute graft-vs-host disease.
Exp Hematol.
1998;26:170-178[Medline]
[Order article via Infotrieve].
4.
Daneshpouy M, Facon T, Jouet JP.
Acute flare-up of conjunctival graft-versus-host disease with eosinophil infiltration in a patient with chronic graft-versus-host disease.
Leukemia and Lymphoma.
2002;43:445-446.
5.
Desreumaux P, Janin A, Dubucquoi S, et al.
Synthesis of interleukin-5 by activated eosinophils in patients with eosinophilic heart diseases.
Blood.
1995;82:1553-1560[Abstract/Free Full Text].
6.
Janin A, Socié G, Devergie A, et al.
Fasciitis in chronic graft-versus-host disease: a clinicopathological study of 14 cases.
Ann Int Med.
1994;120:993-998[Abstract/Free Full Text].
7.
Shulman LE.
Diffuse fasciitis with eosinophilia: a new syndrome?
Trans Assos Am Physicians.
1975;88:70-86.
