allogeneic bone marrow transplantation ( bmt ) is widely used in the treatment of various hematologic disorders , such as leukemia and aplastic anemia , and the major complication of bmt is graft - versus - host disease ( gvhd ) .
we discuss whether autologous melanocyte transplantation is an appropriate way as a treatment of the vitiligo after allogeneic bmt . in this report
we describe a patient with hodgkin 's lymphoma who developed universal vitiligo after allogeneic bmt from his sister .
he underwent four times melanocyte - keratinocyte transplantation ( mkt ) for the treatment of vitiligo ; all treated depigmented patches had a significant repigmentation .
an 18-year - old patient was diagnosed with epstein - barr virus - related hodgkin - like lymphoma in 2003 , and antivirotic had been used to control his lymphoma , but the treatment was ineffective . then in march 2009 , he received the histocompatibility leukocyte antigen ( hla)-matched allogeneic bmt from his sister .
cyclosporine and methotrexate were used as a prophylaxis strategy to prevent gvhd for 6 months after the allogeneic bmt . during the 6-month recovering period ,
the patient developed a small erythematous rash , which was consistent with the clinical features of graft - versus - host disease ( gvhd ) of the skin .
no external agents were used and the rash dissipated in a short period of time .
small depigmented macules started to appear on his cheek 11 months after allogeneic bmt in february 2010 , and followed by rapid progression to the whole body from the face to hands within 1 month .
we indicated it to be a typical universal vitiligo by the reason that the depigmentation macules had a chalky white appearance under wood 's light .
moreover , leukotrichia appeared at the same time associated with his vitiligo , affecting back and arms [ figure 1 ] .
the patient with extensive vitiligo of the back and arms the depigmentation macules did not expanded any more after he received whole - body nb - uvb therapy twice a week for 2 months .
simultaneously , following the doctor 's advice , 0.1% tacrolimus was used and traditional chinese medicine was orally taken .
the patient underwent the therapies mentioned above for 8 months in total , but with poor repigmentation .
then he discontinued medical therapies and performed non - cultured mkt on january 17 , 2011 , including left forehead and temple [ figure 2 ] .
almost complete repigmentation was shown after 8 months since the first transplantation [ figure 3a ] .
then he received mkt on his right face on september 29 , 2011 . and 8 months after the second mkt ,
28 months after the first - time transplantation , all of the transplanted areas had almost completely repigmented and the color of the repigmented area matched with the normal surrounding skin excellently [ figure 3c ] .
then the patient underwent the third and the fourth mkt procedure on the right and the left side of his neck respectively on may 28 , 2012 and january 22 , 2013 [ figure 4a ] .
significant improvement was shown in the area around the left side of his neck while there 's also a majority repigmentation on the right side [ figure 4b and c ] .
no hyperpigmentation , scar , infection and any other adverse effects on both recipient and donor sites by now were noticed .
leukasmus involving the face symmetrical , around the nose , eyes and mouth repigmentation of vitiligo by mkt on his face .
( c ) 28 months after the first time transplantation , significant repigmentation obtained and normal skin achieved mkt performed on his neck .
( b ) 12 months after the surgery of right neck showing nearly 100% repigmentation .
vitiligo is a most common depigmentation disorder and affects 0.5 - 2.0% of the world population .
the etiology of vitiligo remains obscure , the most prevalent hypothesis today considers vitiligo as an autoimmune disease and focuses on a melanocyte - specific cytotoxic t - cell immune reaction in the destruction of melanocytes .
supported that there perhaps be four explanations for the development of vitiligo after bmt , such as the destruction of melanocytes stimulated by pretransplantation chemotherapy and radiotherapy , chronic gvhd , infusion of a larger number of lymphocytes and adoptive passive transfer from the donor to the recipient . in the case of our patient , vitiligo might be a result of an immune response directed against the melanocyte destruction initiated by gvhd . there are reported cases about allogeneic posted - bmt vitiligo .
but most of the pre - bmt diagnosis were chronic myelogenous leukemia , none of them were diagnosed with hodgkin 's lymphoma as our report . in terms of treatment during those cases , just partial of them accepted therapies , but none of them performed with transplantation . in the bmt context , the extensive and relentless vitiligo progression indicated an aggressive alloimmune process , so the destruction of melanocyte is alloimmune in nature .
there was no report to make discriminate of melanocyte destruction between alloimmune and autoimmune , but au et al .
proposed the success of melanocyte autografts for autoimmune vitiligo could be used in an alloimmune setting .
therefore , we came up with the idea of vitiligo melanocyte transplantation while other treatment was invalid for the patient .
melanocyte grafting technique include cultured autologous melanocyte suspension transplantation and autologous noncultured melanocyte - keratinocyte . in our report , the patient obtained universal vitiligo after allogeneic bone marrow transplantation for hodgkin 's lymphoma . in
the condition of vitiligo failed to respond to non - surgical treatment , the patient underwent four times of mkt during 2 years .
the largest area of treated lesions was 50 cm ; repigmentation rate achieved more than 95% after each transplantation without any adverse effects or koebner 's phenomenon .
the pattern of the repigmentation was uniform in the first three times mkt but diffuse in the last one ; whatever , more follow - up time is needed in the future . after 2 years of follow - up , graft sites still repigmented obviously , and the color was similar to the surrounding normal skin which illustrated mkt can treat allogeneic vitiligo successfully .
this is the first time to report about treating vitiligo after allogeneic bone marrow transplantation by mkt .
we suggest that autotransplantation especially autologous grafting with noncultured melanocyte is simple , safe , and inexpensive for remedying the loss of melanocyte after bmt in the case of depigmented macules is stable . but whether the melanocyte transplantation used in alloimmune vitiligo is effective as in autoimmune , we need more follow - ups .
this is the first time to report about treating vitiligo after allogeneic bone marrow transplantation for hodgkin 's lymphoma by non - cultured melanocyte - keratinocyte transplantation without koebner 's phenomenon and adverse effects but all successful .
it probably suggests that therapy of transplantation can be used in the treatment of vitiligo after allogeneic bone marrow transplantation .
 the treatment of vitiligo is derisory since the pathogenesis of vitiligo is not clear at present . 
 most conservative treatments are difficult to approach satisfactory therapy . 
 so transplantation is the only way left when the disease becomes insensitive to those conservative treatments . 
 here we describe an 18-year - old patient who developed vitiligo , which was triggered by graft - versus - host disease after a allogeneic bone marrow transplantation for the treatment of hodgkin 's lymphoma from his sister . in the following treatment to vitiligo , 
 the patient successfully performed the transplantation of autologous uncultured melanocyte on the premise of poor reaction to other conservative methods . 
 we infer that transplantation can be a treatment of the vitiligo after allogeneic bone marrow transplantation . 
Introduction
Case Report
Discussion