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Jason Clark, MD; Lawrence Yao, MD; Steven Z. Pavletic, MD, MS; Michael Krumlauf, RN; Sandra Mitchell, CRNP, PhD; Maria L. Turner, MD; Edward W. Cowen, MD, MHSc

Arch Dermatol. 2009;145(8):918-922.

Background  Sclerotic-type chronic graft-vs-host disease (cGVHD) of the skin is an uncommon but potentially debilitating sequela of allogeneic hematopoietic stem cell transplantation. There is no standardized assessment measure for this form of cGVHD. Because a full-thickness incisional biopsy specimen to the level of the fascia may be needed to make a definitive histologic diagnosis of cGVHD-related fasciitis, a noninvasive technique for the assessment and monitoring of sclerotic-type cGVHD, particularly cGVHD-related fasciitis, would be of potential value.

Observations  Sixty-two consecutive patients with cGVHD following allogeneic hematopoietic stem cell transplantation were evaluated for sclerotic skin disease. Forty-four patients (71%) had cutaneous cGVHD, and 28 patients (45%) had evidence of sclerotic involvement based on physical examination findings. Fifteen patients agreed to undergo research magnetic resonance imaging to evaluate quantifiable changes in the dermis, subcutaneous tissue, and muscle. Among 15 patients, magnetic resonance imaging identified abnormalities in the skin in 7 (47%), subcutaneous fibrous septa in 13 (87%), deep fascia in 12 (80%), epimysium in 9 (60%), and muscle in 3 (20%).

Conclusions  Magnetic resonance imaging should be considered in the evaluation of patients with cGVHD suspected of having subcutaneous or fascial involvement. Additional studies are needed to validate this noninvasive modality for serial monitoring of disease activity and response to therapy.

Trial Registration  clinicaltrials.gov Identifier: NCT00331968

Author Affiliations: Dermatology Branch (Drs Clark, Turner, and Cowen) and Experimental Transplantation and Immunology Branch (Dr Pavletic and Mr Krumlauf), Center for Cancer Research, National Cancer Institute, and Diagnostic Radiology Department (Dr Yao) and Research and Practice Development (Dr Mitchell), Clinical Center, National Institutes of Health, Bethesda, Maryland.

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