NEW YORK (Reuters Health) - In patients with chronic graft-vs-host disease (cGvHD), having a female stem cell donor or a female-donor-to-male-recipient sex mismatch is associated with an increased risk of vitiligo and alopecia areata, according to new findings.

"Our study provides further evidence that stem cell donor sex represents an important transplant-related risk factor for the development of cGVHD," Dr. Edward W. Cowen from the National Cancer Institutes in Bethesda, Maryland, told Reuters Health by email. "Physicians should be aware of the potential for vitiligo and alopecia areata in addition to other more classic skin manifestations of cGVHD, as these conditions may further impact the patient's quality of life and psychosocial health."

cGvHD affects up to 80% of allogeneic hematopoietic stem cell transplantation (HSCT) recipients, but the frequency of skin autoimmune manifestations and associated risk factors have not been well described.

Dr. Cowen's team used data from the National Institutes of Health (NIH) cGvHD natural history study to examine the prevalence of autoantibodies and other risk factors for the development of vitiligo and/or alopecia areata.

Of the 282 adult and pediatric patients included in the study, 15 (5.3%) had vitiligo (14/282, 4.9%) and/or alopecia areata (2/282, 0.7%), they report in JAMA Dermatology, online September 10.

Eleven of the patients (73.3%) had concomitant skin cGvHD at the time of evaluation.

Patients with and without vitiligo and/or alopecia areata did not differ in sex, indication for transplantation, conditioning regimen, cGvHD onset or duration, or intensity of immunosuppression.

On multivariable analysis, however, female sex, female-donor-to-male-recipient sex mismatch, and the presence of anticardiolipin IgG correctly predicted 78.6% of the patients with vitiligo and/or alopecia areata and 70.6% of those without vitiligo and/or alopecia areata.

"Our data provides preliminary evidence that identifying transplant-related risk factors and optimizing selection criteria in donors could possibly prevent the development of vitiligo and/or alopecia areata in patients with cGVHD," Dr. Cowen said.

"Vitiligo and alopecia areata are both uncommon phenomena in patients with cGVHD," he added. "In light of this, no treatments have been systematically evaluated for patients with vitiligo or alopecia areata in this population. Therapeutic options for vitiligo such as topical steroids, ultraviolet light phototherapy, and tacrolimus ointment have been used with variable results. There is no cure for alopecia areata. However, topical and intralesional steroids, minoxidil, and diphenlycycloproprenone (DPCP) are common treatments used to aid in hair regrowth."

The researchers conclude, "Future studies are needed to clarify whether the risk factors identified in this study could lead to better understanding of other autoimmune manifestations in the setting of chronic GvHD."

SOURCE: http://bit.ly/1DltEn5

JAMA Dermatol 2014.