Alopecia areata in Patients with Chronic GVHD

Alopecia areata is more common in GVHD

Allogeneic hematopoetic stem cell transplants (HCT) is a procedure that is frequently performed for patients with blood cancers and other diseases of the bone marrow. The patient's blood cells are replaced by the blood from a donor.

One of the complications of stem cell transplants is the development of an immune based reaction known as graft vs host disease or "GVHD". When the phenomenon by definition occurs more than 100 days after the HCT procedure it is referred to as "chronic" graft vs host disease. It is a serious and potentially life threatening reaction whereby the donor immune cells react against the patient's own cells. Patients with cGVHD can experience a range of skin, gastrointestinal and other issues.

Alopecia areata in cGVHD

Recent studies over the last few years have shown that patients with cGVHD are are much higher risk of developing alopecia areata than previously thought. Alopecia areata is an autoimmune disease that leads to hair loss.

Studies by Ceovic et al suggested that patients with the most severe forms of cGVHD were nearly 4 times more likely to develop alopecia areata or vitiligo (another autoimmune disease affecting the skin pigment cells). Zuo et al showed in 2015 that female donor and female donor to male recipient sex mismatch, in particular, are significantly associated with the development of vitiligo and/or AA. 

Conclusion 

cGVHD is an immune-based complication in patients who have receive stem cell transplants as a treatment for blood cancers and other blood diseases. The incidence of alopecia areata is increased in patients with cGVHD.

References

Čeović R, et al. Croat Med J. 2016.High frequency of cutaneous manifestations including vitiligo and alopecia areata in a prospective cohort of patients with chronic graft-vs-host disease.

Zuo RC, et al. JAMA Dermatol. 2015. Risk factors and characterization of vitiligo and alopecia areata in patients with chronic graft-vs-host disease.