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Jachiet V, Hadjadj J, Zhao LP, Chasset F, Fain O, Fenaux P, Mekinian A. [Dysimmune manifestations associated with myelodysplastic neoplasms and chronic myelomonocytic leukaemias]. Bull Cancer 2023; 110:1147-1155. [PMID: 37414632 DOI: 10.1016/j.bulcan.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 07/08/2023]
Abstract
Systemic inflammatory or autoimmune diseases (SIAD) are observed in up to a quarter of patients with myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML), with a broad clinical spectrum including asymptomatic biological abnormalities, isolated inflammatory clinical manifestations (recurrent fever, arthralgia, neutrophilic dermatoses…) or identified systemic diseases (giant cell arteritis, recurrent polychondritis…). Recent advances in molecular biology have shed new light on the pathophysiological mechanisms that link inflammatory manifestations and myeloid hemopathies, particularly in VEXAS syndrome following the identification of somatic mutations in the UBA1 gene, or in neutrophilic dermatoses with the concept of myelodysplasia cutis. Although the presence of SIAD does not seem to affect overall survival or the risk of transformation into acute myeloid leukemia, their treatment remains a challenge given the frequent high level of corticosteroid dependence as well as the poor efficacy and tolerance (cytopenias, infections) of conventional immunosuppressive agents. Recent prospective data supports the interest of a therapeutic strategy using demethylating agents and notably azacitidine to target the pathological clone.
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Affiliation(s)
- Vincent Jachiet
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Jérôme Hadjadj
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Lin-Pierre Zhao
- Université de Paris Cité, AP-HP, hôpital Saint-Louis, service d'hématologie, 75010 Paris, France
| | - François Chasset
- Sorbonne université, faculté de médecine, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Tenon, service de dermatologie, Paris, France
| | - Olivier Fain
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Pierre Fenaux
- Université de Paris Cité, AP-HP, hôpital Saint-Louis, service d'hématologie, 75010 Paris, France
| | - Arsène Mekinian
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France.
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2
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Lu SY, Yang HF, Zeng QL, Chen P, Chen L, Gao J, Gu XK, Lan H, Luo M. Atypical Sweet syndrome: skin sinus tracts in an acutely febrile patient after lymphoma treatment: a case report. Front Immunol 2023; 14:1193808. [PMID: 37342351 PMCID: PMC10277476 DOI: 10.3389/fimmu.2023.1193808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/18/2023] [Indexed: 06/22/2023] Open
Abstract
Sweet syndrome (SS) is an uncommon inflammatory disease that involves painful skin, edematous, red papules, plaques, or nodules often accompanied by fever and leukocytosis. SS has three subtypes, including classical, malignant-tumor associated, and drug-induced SS (DISS). Patients with DISS have clear histories of recent drug exposure. The incidence of SS is high in hematological malignancy but rare in lymphomas. Glucocorticoid treatment is the recommended treatment for all subtypes of SS. This case study describes a male patient who had a history of sALCL(Systemic anaplastic large cell lymphoma) and was treated with multiple cycles of monoclonal-antibody (mAb) therapy. They also received the G-CSF injection at the site where skin lesions later developed. They met the diagnosis criteria for DISS, which was considered to be caused by the G-CSF injection. In addition, BV(Brentuximab vedotin) administration might predispose them to DISS. This case illustrates the first reported SS during the lymphoma treatment, with rare clinical presentations of local crater-like suppurative skin lesions. This case expands the available literature on SS and hematologic neoplasms and reminds clinicians to promptly recognize and diagnose SS to minimize patient morbidity and long-term sequelae.
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Affiliation(s)
- Shi-Ying Lu
- Department of Hematology, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hui-Fang Yang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Qing-Li Zeng
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Peng Chen
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Li Chen
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Jing Gao
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xue-Kui Gu
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Hai Lan
- Department of HematologyShunde Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Man Luo
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
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Abstract
Systemic auto-inflammatory or autoimmune diseases (SIADs) develop in up to a quarter of patients with myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML). With or without the occurrence of SIADs, the distribution of MDS subtypes and the international or CMML-specific prognostic scoring systems have been similar between MDS/CMML patients. Moreover, various SIADs have been described in association with MDS, ranging from limited clinical manifestations to systemic diseases affecting multiple organs. Defined clinical entities including systemic vasculitis, connective tissue diseases, inflammatory arthritis and neutrophilic diseases are frequently reported; however, unclassified or isolated organ impairment can also be seen. Although the presence of SIADs does not impact the overall survival nor disease progression to acute myeloid leukemia, they can help with avoiding steroid dependence and make associated adverse events of immunosuppressive drugs challenging. While therapies using steroids and immunosuppressive treatment remain the backbone of first-line treatment, increasing evidence suggests that MDS specific therapy (hypomethylating agents) and sparing steroids may be effective in treating such complications based on their immunomodulatory effect. The aim of this review was to analyze the epidemiological, pathophysiological, clinical and therapeutic factors of systemic inflammatory and immune disorders associated with MDS.
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Lepelletier C, Bouaziz JD, Rybojad M, Bagot M, Georgin-Lavialle S, Vignon-Pennamen MD. Neutrophilic Dermatoses Associated with Myeloid Malignancies. Am J Clin Dermatol 2019; 20:325-333. [PMID: 30632096 DOI: 10.1007/s40257-018-00418-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Neutrophilic dermatoses (ND) are a group of conditions characterized by an aseptic accumulation of polymorphonuclear leukocytes in the skin. Occurrence of ND in association with myeloid malignancies, mainly myelodysplastic syndrome and myelogenous acute leukemia, is not rare and is often associated with a poor prognosis. Recent findings have improved understanding of the pathophysiology of myeloid malignancy-associated ND. We review the clinical spectrum of myeloid malignancy-associated ND with an emphasis on recently identified mechanisms. Myeloid leukemia cells retain the potential for terminal differentiation into polymorphonuclear leukocytes in the skin. Many studies suggest a clonal link between myeloid malignancies and ND. Activation of autoinflammatory pathways (NOD-like receptor family pyrin domain-containing-3, Familial Mediterranean Fever Gene) in the clonal cells of myeloid disorders may also be involved in this setting.
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Heath MS, Ortega-Loayza AG. Insights Into the Pathogenesis of Sweet's Syndrome. Front Immunol 2019; 10:414. [PMID: 30930894 PMCID: PMC6424218 DOI: 10.3389/fimmu.2019.00414] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
Sweet's syndrome, also known as Acute Febrile Neutrophilic Dermatosis, is a rare inflammatory condition. It is considered to be the prototype disease of neutrophilic dermatoses, and presents with acute onset dermal neutrophilic lesions, leukocytosis, and pyrexia. Several variants have been described both clinically and histopathologically. Classifications include classic Sweet's syndrome, malignancy associated, and drug induced. The cellular and molecular mechanisms involved in Sweet's syndrome have been difficult to elucidate due to the large variety of conditions leading to a common clinical presentation. The exact pathogenesis of Sweet's syndrome is unclear; however, new discoveries have shed light on the role of inflammatory signaling, disease induction, and relationship with malignancy. These findings include an improved understanding of inflammasome activation, malignant transformation into dermal infiltrating neutrophils, and genetic contributions. Continued investigations into effective treatments and targeted therapy will benefit patients and improve our molecular understanding of inflammatory diseases, including Sweet's syndrome.
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Affiliation(s)
- Michael S Heath
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
| | - Alex G Ortega-Loayza
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
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Nelson CA, Stephen S, Ashchyan HJ, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease. J Am Acad Dermatol 2018; 79:987-1006. [PMID: 29653210 DOI: 10.1016/j.jaad.2017.11.064] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022]
Abstract
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The first article in this continuing medical education series explores the pathogenesis of neutrophilic dermatoses and reviews the epidemiology, clinical and histopathologic features, diagnosis, and management of Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease.
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Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasha Stephen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hovik J Ashchyan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Chan MP, Duncan LM, Nazarian RM. Subcutaneous Sweet syndrome in the setting of myeloid disorders: A case series and review of the literature. J Am Acad Dermatol 2013; 68:1006-15. [DOI: 10.1016/j.jaad.2012.12.954] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/28/2012] [Accepted: 12/03/2012] [Indexed: 11/16/2022]
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Mathieu S, Soubrier M, Tournadre A, Dubost JJ. Neutrophilic dermatosis of the dorsal hands during thalidomide treatment. Int J Dermatol 2013; 53:1133-5. [DOI: 10.1111/j.1365-4632.2012.05714.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sylvain Mathieu
- Department of Rheumatology, Gabriel Montpied Teaching Hospital; Clermont 1 University; Clermont-Ferrand France
| | - Martin Soubrier
- Department of Rheumatology, Gabriel Montpied Teaching Hospital; Clermont 1 University; Clermont-Ferrand France
| | - Anne Tournadre
- Department of Rheumatology, Gabriel Montpied Teaching Hospital; Clermont 1 University; Clermont-Ferrand France
| | - Jean-Jacques Dubost
- Department of Rheumatology, Gabriel Montpied Teaching Hospital; Clermont 1 University; Clermont-Ferrand France
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Abstract
PURPOSE OF REVIEW To highlight the recent observations regarding not only research but also the clinical features and management of Sweet's syndrome. RECENT FINDINGS Some of the new insights concerning Sweet's syndrome include: (1) bortezomib-induced Sweet's syndrome (some of which are the histiocytoid variant), (2) a rare extracutaneous manifestation of Sweet's syndrome with cardiovascular involvement including coronary artery occlusion, and (3) the possibility that photosensitivity may have a role in the pathogenesis of Sweet's syndrome. SUMMARY Animal models of Sweet's syndrome and new associated medication have been observed. The definitive mechanism of pathogenesis still remains to be elucidated. Recent observations in paediatric patients suggest evaluation of dermatosis-related cardiac involvement in patients with post-Sweet's syndrome cutis laxa. Treatment advances include antitumour necrosis factor- alpha drugs; however, these medications have also been associated with inducing Sweet's syndrome. Nearly 50 years after the initial description of an acute febrile neutrophilic dermatosis by Dr Robert Douglas Sweet, the dermatosis remains a fascinating condition with regard to laboratory investigation, clinical manifestations and treatment.
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Curto Barredo L, Salar A, Pujol RM, Garcia M, Gallardo F. Lenalidomide-induced paronychia. J Dermatol 2013; 40:303-4. [DOI: 10.1111/1346-8138.12045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Antonio Salar
- Department of Hematology; Hospital del Mar; Barcelona; Spain
| | - Ramon M. Pujol
- Department of Dermatology; Hospital del Mar; Barcelona; Spain
| | - Mar Garcia
- Department of Pathology; Hospital del Mar; Barcelona; Spain
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Paydas S. Sweet's syndrome: A revisit for hematologists and oncologists. Crit Rev Oncol Hematol 2013; 86:85-95. [DOI: 10.1016/j.critrevonc.2012.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 08/09/2012] [Accepted: 09/06/2012] [Indexed: 12/26/2022] Open
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Raza S, Kirkland RS, Patel AA, Shortridge JR, Freter C. Insight into Sweet's syndrome and associated-malignancy: a review of the current literature. Int J Oncol 2013; 42:1516-22. [PMID: 23546524 DOI: 10.3892/ijo.2013.1874] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/05/2013] [Indexed: 12/21/2022] Open
Abstract
Sweet's syndrome (acute febrile neutrophilic dermatosis) is an infrequent skin disease characterized by sudden onset of fever, leucocytosis and erythematous plaques or nodules infiltrated by neutrophils. There are three main clinical settings in which Sweet's syndrome has been described: classical or idiopathic Sweet's syndrome, malignancy-associated Sweet's syndrome and drug-induced Sweet's syndrome. Classical Sweet's is often preceded by an upper respiratory tract infection and may be associated with inflammatory bowel disease and pregnancy. Approximately 21% of patients have an associated malignancy, most commonly hematological disease. The syndrome may occur as a paraneoplastic accompaniment to established cancer or may be a first sign of malignancy or its recurrence. The incidence is said to be increasing in recent years due to the frequent use of growth factors in cancer patients. Several anticancer agents including all-trans-retinoic acid proteosome inhibitors, hypomethylating agents, tyrosine kinase inhibitors and lenalidomide are potential harbingers of Sweet's syndrome. Unfortunately, little is known about the pathophysiology of Sweet's syndrome and there are no established guidelines for treatment of malignancy-associated Sweet's syndrome. Systemic corticosteroids are the mainstay of treatment. Sweet's syndrome caused by anticancer agents sometimes involves withdrawal or temporary discontinuation of anticancer agents, use of systemic corticosteroids and/or rechallenge with either with the same anticancer agents or different agents. This report provides insights into the pathophysiology, clinical presentation, diagnostic work, differential diagnosis and management of malignancy-associated Sweet's syndrome published in reported cases.
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Affiliation(s)
- Shahzad Raza
- Division of Hematology and Oncology, Ellis Fischel Cancer Center, Columbia, MO 65203, USA.
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Lenalidomide-induced purpuric eruption: A new adverse cutaneous reaction. J Am Acad Dermatol 2011; 65:654-656. [DOI: 10.1016/j.jaad.2010.04.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 03/17/2010] [Accepted: 04/22/2010] [Indexed: 11/24/2022]
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Tageja N, Giorgadze T, Zonder J. Dermatological complications following initiation of lenalidomide in a patient with chronic lymphocytic leukaemia. Intern Med J 2011; 41:286-8. [DOI: 10.1111/j.1445-5994.2011.02426.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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