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KMID : 0363220070450101041
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Korean Journal of Dermatology
2007 Volume.45 No. 10 p.1041 ~ p.1047
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A Clinical Study of Late-onset-acute-cutaneous Graft versus Host Disease
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Kim Myung-Hwan
Park Hyun-Jeong
Lee Jun-Young
Cho Baik-Kee
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Abstract
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Background: Graft versus host disease (GVHD) has been traditionally divided into acute GVHD and chronic GVHD based on the period after transplantation. However, a distinct type of GVHD has recently been recognized as late onset acute GVHD(LaGVHD). LaGVHD develops in the period of chronic GVHD, which is after 100 day after stem cell transplantation (SCT), but has clinical and histologic features of acute cutaneous GVHD.
Objective: We reviewed the clinical and histological features of LaGVHD, acute GVHD and chronic GVHD patients who had been consulted from the department of hematology in St. Mary’s hospital from Jul 1999 to May 2005.
Methods: 104 acute GVHD patients, 27 chronic GVHD patients and 10 LaGVHD patients were included in this study. Each patient’s clinical and histological findings, medication history, and involvement of other organ systems were retrospectively evaluated.
Results: LaGVHD has the same clinical manifestation and histopathology as acute GVHD. We could not discriminate LaGVHD from GVHD on the basis of clinical manifestation or histopathology alone. Only 5 patients (18.5%) experienced explicit acute GVHD in the chronic GVHD patients group. Most LaGVHD (8 patients, 80%) had multiple episodes of acute cutaneous GVHD attacks within 100 days after transplantation. Therefore, in these patients, acute cutaneous GVHD had developed over in the acute and chronic phases. Interestingly, 4 patients (40%) of the LaGVHD group concomitantly developed sicca syndrome or chronic inflammation of gastrointestinal tracts.
Conclusion: Because of the limited number of patients, we could not delicately describe the subtle characteristics of LaGVHD. In addition, the clinically complicated features of LaGVHD make it difficult to categorize definitely LaGVHD into acute or chronic GVHD. Based on our observations, LaGVHD may represent a distinct type of graft versus host reaction.
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KEYWORD
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Late onset acute GVHD, Late appearance of acute GVHD
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