Drugs as a frequent cause of acute rash in patients after CD34(+)-selected peripheral blood stem cell transplantation Journal Article
| Authors: | Klager, S.; Lacouture, M. E.; Hannum, M.; Devlin, S. M.; Maloy, M.; Pulitzer, M.; Jakubowski, A. A.; Markova, A. |
| Article Title: | Drugs as a frequent cause of acute rash in patients after CD34(+)-selected peripheral blood stem cell transplantation |
| 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. © 2019 American Society for Transplantation and Cellular Therapy |
| Keywords: | adult; human tissue; middle aged; antibiotic agent; major clinical study; histopathology; cd34 antigen; drug eruption; skin biopsy; cohort analysis; retrospective study; age; pruritus; rash; acute graft versus host disease; disease severity; graft versus host reaction; allogeneic hematopoietic stem cell transplantation; antihypertensive agent; gvhd; peripheral blood stem cell transplantation; diuretic agent; keratinocyte growth factor; recombinant interleukin 7; thymocyte antibody; contact dermatitis; eosinophil count; eosinophilia; graft-versus-host disease; folliculitis; seborrheic dermatitis; t cell depleted; human; male; female; article; drug rash; cd34+- selected; tcd |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 25 |
| Issue: | 11 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2019-11-01 |
| Start Page: | 2172 |
| End Page: | 2180 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2019.07.009 |
| PUBMED: | 31306779 |
| PROVIDER: | scopus |
| PMCID: | PMC6876686 |
| DOI/URL: | |
| Notes: | Source: Scopus |
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