Severe vulgaris psoriatic patients with acute myelogenous leukaemia and resolution after allogeneic bone marrow transplantation/ peripheral blood stem cell transplantation

摘要

Psoriasis is a common disease with a prevalence of up to 2% in the world population. The pathophysiological mechanism of this inflammatory disease has not been determined although it is generally accepted to have a genetic predisposition and be T-cell mediated. The lymphocytes are the target of psoriatic therapeutic strategies. Therapy resolves psoriasis for a time, but induces some severe side effects. Some cases of severe psoriasis, treated with multiple therapeutic regimens for many years, developed leukemia. Currently, research is being focused on whether psoriatic patients have a propensity to develop leukaemia. Some studies showed that psoriatic patients have chromosomal instability and a defect in DNA repair in some of their cells. Qiu investigated Chinese patients with chromosome aberration of bone marrow cells in 19 cases of psoriasis associated with leukemia, and chromosomal aberration of lymphocytes in peripheral blood in 14 cases of untreated psoriasis. Hyperdiploid chromosomal abnormality was found in the untreated psoriatic patients. The rate of appearance of hyperdiploid chromosomes in patients with psoriasis was higher than in controls, especially in psoriatic patients with leukemia. In some patients with psoriatsis associated leukaemia, chromosomal instability is related to defect in DNA repair. Besides the analysis of hyperdiploid chromosomes, fragile sites of these patients ' chromosome were studied with G-banding. The chromosomal fragile sites 3p14 (7 sites), 7q32 (5) and 15q23 (3) was higher in psoriatic patients than in normal controls. Some therapeutic regimens for severe psoriatic patients such as bimolane, photochemotherapy with psoralen and ultraviolet A may induce aberrations in chromosomes in patients' cells. The regimens may accelerate the gene mutation of chromosome fragile sites in patients with severe psoriasis. In this study, clinical data, and laboratory results of 16 psoriatic patients with leukaemia suggested that the onset of leukaemia is related to preexisting severe psoriasis.