Skin Lesion Reconstruction in Graft Versus Host Disease Using Autograft From the Bone Marrow Donor Panniculectomy Tissue.

Abstract

Chronic graft-versus-host disease (cGVHD) is a common complication following hematopoietic stem cell transplant, with the skin being the most frequently affected organ. The cutaneous manifestations may be refractory to conventional wound care and skin autografts due to the complex underlying immunology. In this case report, a pediatric patient with a history of Ph-like B-cell acute lymphoblastic leukemia underwent a haploidentical bone marrow transplant from his mother. His course was complicated by cutaneous cGVHD, which failed multiple lines of immunosuppression and conservative wound management. In addition, he developed multidrug-resistant wound infections. He underwent split-thickness skin allograft transplantation from his mother's pannus, and his wounds were largely resolved within 3 months postoperatively. This report provides a review of the literature to discuss the biology behind cutaneous cGVHD, including the role of the microbiome, and the proposed mechanism for the success of this treatment. It also highlights the unique benefits of utilizing the pannus and leveraging the immunologic tolerance established by prior bone marrow transplant from the same donor. This case presents donor skin allografting in the setting of donor tolerance as a viable option for refractory cutaneous cGVHD.