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Allogeneic Hematopoietic Stem Cell Transplantation in Cutaneous T-Cell Lymphomas. Cancers (Basel) 2020; 12:cancers12102856. [PMID: 33023002 PMCID: PMC7601655 DOI: 10.3390/cancers12102856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Advanced-stage cutaneous T-cell lymphomas are aggressive diseases with frequent disease relapses and a reduced overall survival. Most treatment regimens fail to induce long-term remissions. Allogeneic hematopoietic stem cell transplantation has been associated with treatment-free long-term remissions and holds a potential for cure in this disease but is associated with frequent complications, mostly linked to the development of graft-versus-host disease and infections. Herein, we review the current evidence supporting the use of allogeneic stem cell transplantation in advanced-stage cutaneous T-cell lymphomas. Abstract Cutaneous T-cell lymphomas (CTCLs) are non-Hodgkin lymphomas that develop primarily in the skin. They account for almost 80% of primary cutaneous lymphomas. Epidermotropic CTCLs (mycosis fungoides (MF) and Sézary syndrome (SS)) are the most common form of CTCL. The course of the disease ranges from an indolent clinical behavior in early-stage disease to an aggressive evolution in the advanced stages. Advanced-stage disease is defined by the presence of tumors, erythroderma, or significant blood, nodal or visceral involvement. Advanced-stage disease is characterized by frequent disease relapses, refractory disease, a severely impaired quality of life and reduced overall survival. In the last twenty-five years, allogeneic hematopoietic stem cell transplantation (HSCT) has led to prolonged remissions in advanced CTCL, presumably linked to a graft-versus-lymphoma effect and is thus emerging as a potential cure of the disease. However, the high post-transplant relapse rate and severe morbidity and mortality associated with graft-versus-host disease and infections are important issues. Allogeneic HSCT is thus mostly considered in young patients with no comorbidities and an aggressive, advanced-stage CTCL. Allogeneic HSCT gives the best results in patients with a pre-transplant complete remission of the lymphoma. For this reason, one of the challenges is to define the best time to consider allogeneic HSCT in the disease course. Early identification of patients at high risk for progression is important to identify candidates who may benefit from allogeneic HSCT before their disease becomes treatment-refractory. This review describes the role of allogeneic HSCT in CTCL, summarizes the published data and future perspectives in this area.
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Klager S, Lacouture ME, Hannum M, Devlin SM, Maloy M, Pulitzer M, Jakubowski AA, Markova A. Drugs as a Frequent Cause of Acute Rash in Patients after CD34 +-Selected Peripheral Blood Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:2172-2180. [PMID: 31306779 PMCID: PMC6876686 DOI: 10.1016/j.bbmt.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/18/2019] [Accepted: 07/03/2019] [Indexed: 12/12/2022]
Abstract
Although histopathological differences have been reported between acute graft-versus-host disease (aGVHD) rash and non-aGVHD rash in CD34+-selected peripheral blood stem cell transplantation (PBSCT) recipients, skin biopsy alone is usually insufficient to determine rash etiology. As such, distinguishing inflammatory non-aGVHD rashes, such as drug eruptions, from cutaneous aGVHD after CD34+-selected PBSCT remains challenging and relies on clinical presentation. This study aimed to identify etiologies of skin rash in the first year after CD34+-selected PBSCT and to assess whether laboratory serologic markers, transplant characteristics, and rash morphology and symptomatology aid in differentiation of cutaneous aGVHD rash versus non-aGVHD rash. We conducted a retrospective study of 243 adult patients who underwent CD34+-selected PBSCT at Memorial Sloan Kettering Cancer Center between 2008 and 2011. Among this cohort of transplant recipients, only 43 patients (17.7%) developed cutaneous aGVHD. A total of 152 patients (63%) were identified with rash within 1 year after PBSCT. The proportion of patients who experienced peripheral eosinophilia was not different between those with an aGVHD versus non-aGVHD rash (P ≥ .90), nor when stratified by CD34+ selection method (Isolex, P = .70; CliniMACS, P≥ .90). The proportion of patients with pruritus was also not different between those with an aGVHD rash versus non-aGVHD rash (P= .20), or when stratified by CD34+ selection modality (Isolex, P = .20; CliniMACS, P = .50). The most common cause of non-aGVHD rash among those with a clear etiology was drug (39% of Isolex; 26% of CliniMACS). Single drug culprits were identified in 51% of drug rashes. The most commonly reported offending agents included antibiotics, keratinocyte growth factor, chemotherapy, and recombinant glycosylated human IL-7.
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Affiliation(s)
- Skylar Klager
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, Cornell University, New York, New York
| | - Margaret Hannum
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Molly Maloy
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Pulitzer
- Weill Cornell Medical College, Cornell University, New York, New York; Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ann A Jakubowski
- Weill Cornell Medical College, Cornell University, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, Cornell University, New York, New York.
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Menter T, Medani H, Olavarria E, Kanfer E, Naresh KN. Pathology findings in patients with cutaneous T-cell lymphomas treated with allogeneic haematopoietic stem cell transplantation. Br J Haematol 2016; 180:904-908. [DOI: 10.1111/bjh.14479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Menter
- Department of Cellular and Molecular Pathology; Hammersmith Hospital Campus; Imperial College Healthcare NHS Trust; London UK
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - Hanine Medani
- Department of Cellular and Molecular Pathology; Hammersmith Hospital Campus; Imperial College Healthcare NHS Trust; London UK
| | - Eduardo Olavarria
- Department of Haematology; Hammersmith Hospital Campus, Imperial College Healthcare NHS Trust; London UK
| | - Edward Kanfer
- Department of Haematology; Hammersmith Hospital Campus, Imperial College Healthcare NHS Trust; London UK
| | - Kikkeri N. Naresh
- Department of Cellular and Molecular Pathology; Hammersmith Hospital Campus; Imperial College Healthcare NHS Trust; London UK
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Lowell DL, Salvo NL, Weily WJ, Swiatek M, Sahli H. Multiple Eccrine Syringofibroadenoma of Mascaro of the Lower Extremity. J Am Podiatr Med Assoc 2016; 106:433-438. [PMID: 28033055 DOI: 10.7547/15-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Eccrine syringofibroadenoma (ESFA) is a rare benign lesion of ductal and secretory differentiation exhibiting multiple cutaneous polymorphic presentations with an unknown etiology. We present a case of ESFA that uniquely exhibited large, thick, verrucous-like hyperplastic growths as well as superficial shiny mosaic plaques and deep ulcerations in three different anatomical locations in the same patient. The diagnosis of ESFA was confirmed histologically after biopsies were performed on all of the affected areas. In addition to a case report and literature review, we also present classification, clinical, and histologic aspects of ESFA.
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Affiliation(s)
- Danae L. Lowell
- Department of Surgery, Cleveland VA Medical Center, Cleveland, OH
| | - Nichol L. Salvo
- Young Physicians' Program, American Podiatric Medical Association, Bethesda, MD. Dr. Salvo is now with the Podiatry Section and Podiatry Residency Program, Atlanta VA Medical Center, Decatur, GA
| | | | - Michael Swiatek
- Private practice, Schwein Foot & Ankle Clinic, Mansfield, OH
| | - Hannah Sahli
- Kent State University College of Podiatric Medicine, Independence, OH
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Young JAH, Weisdorf DJ. Infections in Recipients of Hematopoietic Stem Cell Transplants. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7152282 DOI: 10.1016/b978-1-4557-4801-3.00312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zitelli K, Fernandes N, Adams BB. Eosinophilic folliculitis occurring after stem cell transplant for acute lymphoblastic leukemia: a case report and review. Int J Dermatol 2014; 54:785-9. [DOI: 10.1111/ijd.12521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Kristine Zitelli
- Department of Dermatology; University of Cincinnati; Cincinnati OH USA
| | - Neil Fernandes
- Department of Dermatology; University of Cincinnati; Cincinnati OH USA
| | - Brian B. Adams
- Department of Dermatology; University of Cincinnati; Cincinnati OH USA
- Section of Dermatology; Veterans Affairs Medical Center; Cincinnati OH USA
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Omer AK, Kim HT, Yalamarti B, McAfee SL, Dey BR, Ballen KK, Attar E, Chen YB, Spitzer TR. Engraftment syndrome after allogeneic hematopoietic cell transplantation in adults. Am J Hematol 2014; 89:698-705. [PMID: 24668776 DOI: 10.1002/ajh.23716] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 12/21/2022]
Abstract
We performed a retrospective study of the engraftment syndrome (ES) as defined by the Spitzer Criteria in adult patients undergoing allogeneic hematopoietic cell transplantation (HCT) for various hematological malignancies at a single institution, over a decade, and analyzed its relationship to acute GVHD; 217 patients underwent either myeloablative (38.7%) or reduced intensity (61.3%) HCT; 22.1% met the criteria for ES. Acute GVHD prophylaxis (P = 0.006) and transplants prior to 2006 (P < 0.0001) were significantly associated with a risk of ES in univariable analysis. Early aGVHD within 4 weeks of engraftment was significantly more common in the ES compared to the non ES cohort (21 vs. 8.3% respectively, P = 0.02). ES did not predict for future GVHD, as at day +180, the cumulative incidences of grades II-IV aGVHD (31 vs. 23%, P = 0.19) and of chronic GVHD at 2 years of engraftment (42 vs. 36%, P = 0.28) were not significantly different between the ES and non ES groups, respectively. No significant differences in NRM, overall survival and progression-free survival were observed between the two groups. Although predictive of early aGVHD, ES occurred independently of GVHD in 79% of the patients. Survival outcomes should be evaluated in a larger randomized study to investigate if there is a correlation with ES.
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Affiliation(s)
- Aazim K. Omer
- Division of Hematology; Oncology and Transplantation, University of Minnesota; Minneapolis Minnesota
- Department of Medicine; University of Minnesota; Minneapolis Minnesota
| | - Haesook T. Kim
- Department of Biostatistics and Computational Biology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Bhargavi Yalamarti
- Hematology/Oncology Division; University of Massachusetts; Worcester Massachusetts
- Department of Medicine; University of Massachusetts; Worcester Massachusetts
| | - Steven L. McAfee
- Hematology/Oncology Division; Massachusetts General Hospital; Boston Massachusetts
- Department of Medicine; Massachusetts General Hospital; Boston Massachusetts
| | - Bimalangshu R. Dey
- Hematology/Oncology Division; Massachusetts General Hospital; Boston Massachusetts
- Department of Medicine; Massachusetts General Hospital; Boston Massachusetts
| | - Karen K. Ballen
- Hematology/Oncology Division; Massachusetts General Hospital; Boston Massachusetts
- Department of Medicine; Massachusetts General Hospital; Boston Massachusetts
| | - Eyal Attar
- Hematology/Oncology Division; Massachusetts General Hospital; Boston Massachusetts
- Department of Medicine; Massachusetts General Hospital; Boston Massachusetts
| | - Yi-Bin Chen
- Hematology/Oncology Division; Massachusetts General Hospital; Boston Massachusetts
- Department of Medicine; Massachusetts General Hospital; Boston Massachusetts
| | - Thomas R. Spitzer
- Hematology/Oncology Division; Massachusetts General Hospital; Boston Massachusetts
- Department of Medicine; Massachusetts General Hospital; Boston Massachusetts
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Han Q, Sun M, Wu L, Chen J, Wang W, Liu C, Chen H, Du G. Primary distal femur T-cell lymphoma after allogeneic haematopoietic stem cell transplantation for chronic myeloid leukaemia: a rare case report and literature review. J Int Med Res 2014; 42:598-605. [PMID: 24501166 DOI: 10.1177/0300060513507646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Post-transplant lymphoproliferative disorders originating from T lymphocytes are a rare complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT) that are not usually associated with Epstein-Barr virus infection. A male patient diagnosed at the age of 15 years with chronic myeloid leukaemia (in the chronic phase) was initially treated with oral hydroxyurea. The disease entered an accelerated phase when the patient was 22 years old. Complete remission was achieved after one course of homoharringtonine and cytarabine. The patient then underwent human leucocyte antigen-matched sibling donor allo-HSCT. Just over 6.5 years after the allo-HSCT, a second primary tumour was located in the distal femur and diagnosed as T-cell non-Hodgkin's lymphoma (stage IV, group B). This was treated with various chemotherapy and radiotherapy regimens, but the outcomes were poor and the disease progressed. The T-cell lymphoma invaded many sites, including the skeleton, spleen and skin, and the patient died within 8 months of the diagnosis. This current case report highlights the need for the early detection and prevention of subsequent primary malignancies after allo-HSCT.
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Affiliation(s)
- Qiaoyan Han
- Department of Haematology, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang, Jiangsu Province, China
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An epidermotypic model of interface dermatitis reveals individual functions of fas ligand and gamma interferon in hypergranulosis, cytoid body formation, and gene expression. Am J Dermatopathol 2011; 33:244-50. [PMID: 21430507 DOI: 10.1097/dad.0b013e3181f1b200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Analysis of complex cutaneous reactions using animal models allows for the identification of essential or modulatory participants, that is, cyto- and chemokines or adhesion molecules. However, complex whole animal modeling is bound to obscure some specific contributions of individual players. Mouse models suggest that expression of Fas ligand (FasL) by donor T cells is essential for the cutaneous acute graft-versus-host reaction (aGvHR), a major complication after allogeneic hematopoietic stem cell transplantation. The role of FasL/Fas in human cutaneous GvHR is not known. To understand the mechanisms of cytotoxicity and inflammation in human cutaneous GvHR, we developed an organotypic model using reconstructed human epidermis (RHE) that was exposed to FasL, gamma-interferon (IFNγ), or both. The model recapitulated key histological hallmarks of cutaneous aGvHR, including interface dermatitis, appearance of cytoid bodies, hypergranulosis, and expression of ICAM-1. Cytoid body formation and expression of ICAM-1 were attributable entirely to IFNγ, whereas hypergranulosis was triggered by FasL. Both FasL and IFNγ triggered vacuolar degeneration of keratinocytes. The validity of the RHE model of GvHR was demonstrated by histological correlation with biopsied skin from patients with acute graft-versus-host disease. FasL and IFNγ each elicited potent and specific proinflammatory genomic responses in RHE. Inhibition of caspase activity dramatically augmented the FasL-induced proinflammatory responses, suggesting an "apoptosis-versus-inflammation" antagonism in cutaneous aGvHR and other lichenoid dermatoses.
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van Dorp S, Resemann H, te Boome L, Pietersma F, van Baarle D, Gmelig-Meyling F, de Weger R, Petersen E, Minnema M, Lokhorst H, Ebeling S, Beijn SJP, Knol EF, van Dijk M, Meijer E, Kuball J. The immunological phenotype of rituximab-sensitive chronic graft-versus-host disease: a phase II study. Haematologica 2011; 96:1380-4. [PMID: 21546493 DOI: 10.3324/haematol.2011.041814] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Chronic graft-versus-host disease is the major long-term complication after allogeneic stem cell transplantation with a suboptimal response rate to current treatments. Therefore, clinical efficacy and changes in lymphocyte subsets before and after rituximab treatment were evaluated in a prospective phase II study in patients with steroid-refractory chronic graft-versus-host disease. Overall response rate was 61%. Only responding patients were found to have increased B-cell numbers prior to treatment. B cells had a naïve-antigen-presenting phenotype and were mainly CD5 negative or had a low CD5 expression. Normal B-cell homeostasis was reestablished in responding patients one year after ritxumab treatment and associated with a significant decline in skin-infiltrating CD8(+) T cells, suggesting that host B cells play a role in maintaining pathological CD8(+) T-cell responses. Imbalances in B-cell homeostasis could be used to identify patients a priori with a higher chance of response to rituximab treatment (Eudra-CT 2008-004125-42).
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Länger F, Puls F, Buchholz S, Loddenkemper C, Ganser A, Kreipe H. Histopathologie der Graft-versus-Host-Erkrankung. DER PATHOLOGE 2011; 32:144-51. [DOI: 10.1007/s00292-010-1408-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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12
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Santos-Briz A, Romo A, Antúnez P, Román C, Alcoceba M, Garcia JL, Vazquez L, González M, Unamuno P. Primary cutaneous T-cell lymphoproliferative disorder of donor origin after allogeneic haematopoietic stem-cell transplantation. Clin Exp Dermatol 2009; 34:e778-81. [PMID: 19817764 DOI: 10.1111/j.1365-2230.2009.03509.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 56-year-old male patient had a history of mantle-cell lymphoma, which was treated with polychemotherapy and reduced-intensity conditioning allogeneic haematopoietic stem cell transplantation (ASCT) from his healthy sister with an identical human leucocyte antigen profile. Six years after transplantation, the patient developed asymptomatic eczema-like cutaneous lesions. Histologically the lesions contained a dense superficial lichenoid infiltrate, mainly consisting of CD4+ atypical medium to large lymphocytes showing indented hyperchromatic nuclei. In situ hybridization for Epstein-Barr virus was negative. PCR amplification of the T-cell receptor-gamma chain gene from several lesions revealed a monoclonal rearrangement without clonal variation. Two-colour fluorescence in situ hybridization (X and Y chromosomes) and microsatellite genotyping were used to compare samples from the patient (transplant recipient), his sister (donor) and the skin biopsy sample, which confirmed that the origin of the neoplastic cells was the donor graft. To our knowledge, this is the first case of post-transplant primary cutaneous T-cell lymphoproliferative disorder after ASCT.
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Affiliation(s)
- A Santos-Briz
- Department of Pathology, Hospital Universitario de Salamanca, Salamanca, Spain.
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Lee HT, Chen WS, Chou CT, Chen MH, Tsai CY. Chronic graft-versus-host disease mimicking rapid progressive rheumatoid arthritis with atlantoaxial subluxation. BMJ Case Rep 2009; 2009:bcr06.2009.1941. [PMID: 21887156 DOI: 10.1136/bcr.06.2009.1941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic graft-versus-host disease (cGVHD) may mimic clinical and serological features of various autoimmune diseases. We present a case of a 23-year-old man who developed vitiligo, symmetric polyarthritis, high titre rheumatoid factor, antinuclear antibodies and anti-double stranded DNA antibodies after allogenic peripheral blood stem cell transplantation for severe aplastic anaemia. He was treated with low dose oral steroids, non-steroid anti-inflammatory drugs and azathioprine and clinical improvement of polyarthritis were observed initially. However, atlantoaxial subluxation (C1-C2) and rapid progression of symmetrical joint space narrowing in knees and wrists developed within 1 year. cGVHD mimicking rheumatoid arthritis with unusual presentations was observed in this patient.
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Affiliation(s)
- Hui-Ting Lee
- Taipei Veterans General Hospital, Division of Allergy, Immunology & Rheumatology, 201 Shih-Pai Road Section 2, Taipei, 112, Taiwan
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Osband A, Laskow D, Mann R, Berkowicz T, Ianosi-Irimie M, Boruchoff S. Sweet Syndrome After Kidney Transplantation. Transplant Proc 2009; 41:1954-6. [DOI: 10.1016/j.transproceed.2009.03.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 03/10/2009] [Indexed: 10/20/2022]
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Abstract
The clinical findings of fever and skin rash with or without evidence of fluid retention, which mimic engraftment syndrome, have been observed during the pre-engraftment period in patients undergoing hematopoietic stem cell transplantation. In order to characterize this newly observed clinical syndrome called pre-engraftment syndrome (pES), we retrospectively analyzed the clinical records of 50 patients. Three out of 14 patients (23.1%) who underwent cord blood stem cell transplantation developed non-infectious fever, skin rash, and tachypnea 4-15 days prior to neutrophil engraftment. Two patients spontaneously recovered with fluid restriction and oxygen inhalation. One patient died of a complicated pulmonary hemorrhage in spite of aggressive supportive therapy and steroid treatment. Four out of 23 patients (17.4%) who underwent allogeneic bone marrow transplantation developed non-infectious fever and skin rash 4 to 5 days prior to neutrophil engraftment. All four of these patients recovered with only steroid treatment. These characteristic findings were not observed in patients who had undergone autologous peripheral blood stem cell transplantation. Interestingly, the speed of neutrophil engraftment was significantly faster for the patients suffering from pre-engraftment syndrome. The close observation and further pathophysiological research are required to better understand this syndrome.
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Affiliation(s)
- Young-Ho Lee
- Department of Pediatrics & Hematopoietic Stem Cell Transplantation Center, Hanyang University Medical Center, Seoul, Korea.
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Kotani A, Hori T, Fujita T, Kambe N, Matsumura Y, Ishikawa T, Miyachi Y, Nagai K, Tanaka Y, Uchiyama T. Involvement of OX40 ligand+ mast cells in chronic GVHD after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2007; 39:373-5. [PMID: 17277792 DOI: 10.1038/sj.bmt.1705587] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Delgado-Jimenez Y, Goiriz R, Vargas-Diez E, Fraga J, Garcia-Diez A, Fernandez-Herrera J. Acute graft-versus-host disease (GVHD) overlapping chronic GVHD after reinduction chemotherapy. Br J Dermatol 2007; 156:388-90. [PMID: 17223891 DOI: 10.1111/j.1365-2133.2006.07630.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chinnakotla S, Smith DM, Domiati-Saad R, Agura ED, Watkins DL, Netto G, Uemura T, Sanchez EQ, Levy MF, Klintmalm GB. Acute graft-versus-host disease after liver transplantation: role of withdrawal of immunosuppression in therapeutic management. Liver Transpl 2007; 13:157-61. [PMID: 17192857 DOI: 10.1002/lt.20982] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Graft-versus-host disease (GVHD) after liver transplantation is rare but associated with a very high mortality (over 85%). Most treatments focus on increasing immunosuppression, addition of antibody preparations such as OKT3 and antithymocyte globulin to eliminate the donor lymphocytes, and supporting myelopoiesis by use of cytokines. However, the results are very poor. We reasoned that a better therapeutic approach would be to reduce the immunosuppression and allow the patient's immune system an opportunity to reject the allograft donor T cells. We tested this novel therapeutic approach in 3 patients diagnosed with GVHD. Two patients had rapid loss of donor T cell chimerism and resolution of their symptoms. The other patient continued to progress to severe GVHD and died. The patients who responded to withdrawal of immunosuppression had a later onset of symptoms and a lower level of donor CD3+ T cells at the start of treatment. We conclude that larger studies are needed to further evaluate these results and to determine what factors may affect the likelihood that a patient may respond to this approach.
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Canninga-van Dijk MR, van der Straaten HM, Fijnheer R, Sanders CJ, van den Tweel JG, Verdonck LF. Anti-CD20 monoclonal antibody treatment in 6 patients with therapy-refractory chronic graft-versus-host disease. Blood 2004; 104:2603-6. [PMID: 15251978 DOI: 10.1182/blood-2004-05-1855] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chronic graft-versus-host disease (cGVHD) is an important determinant of long-term morbidity and mortality in allogeneic stem cell transplantation patients. Because cGVHD has clinical, histologic, and laboratory findings of autoimmune diseases and anti-B-cell therapy has shown efficacy in autoimmune diseases, we hypothesized that monoclonal anti-CD20 antibody therapy might improve patients with cGVHD. We treated 5 men and 1 woman with therapy-refractory extensive cGVHD with anti-CD20 monoclonal antibody. Intravenous infusion was given at a weekly dose of 375 mg/m(2) for 4 weeks. In case of incomplete clinical response, additional courses of 4 weeks were given. Five patients responded to treatment with marked clinical, biochemical, and histologic improvement. One patient failed to respond. Anti-CD20 monoclonal antibody seems to be effective in cGVHD. A controlled trial is mandatory to confirm these results. The outcome of this study suggests a participating role of B cells in the pathogenesis of cGVHD.
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Affiliation(s)
- Marijke R Canninga-van Dijk
- Department of Pathology H 04-312, University Medical Centre, PO Box 85500, 3508 GA Utrecht, the Netherlands.
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