Neuropathic dermatomes and cutaneous ulceration in patients with chronic GVHD

摘要

We report two cases of severe ulcerative cutaneous chronic GVHD (cGVHD) that involved areas of sensory loss. The report highlights the importance of meticulous wound care and injury prevention measures to reduce the risk of this complication. Patient #1 is a 56-year-old African-American female who received an allogeneic transplant using matched related donor PBSCs in February 2009 as treatment for stage IVB diffuse large B-cell lymphoma who had failed initial therapy with R-CHOP in 2005, and then relapsed after a salvage regimen of rituximab, ifosphamide, cisplatin and etoposide followed by carmustine, etoposide, cytosine arabinoside, melphalan and rituximab with autologous SCT in 2006. Before her allogeneic transplant, she received fully ablative conditioning with 60 mg/kg/day for 2 days of CY and TBI (1200cGy), and tacrolimus (targeted to 10mug/L) and methotrexate (5 mg/m2 on day +1, +6, +9 and +11) were used as GVHD prophylaxis. Neutrophil and platelet engraftment were on days 17 and 11, respectively and blood STRs confirmed 100% donor chimerism by day 17. On day 31 she developed, grade III acute GVHD with diffuse rash, liver enzyme elevation and diarrhea; colonoscopy and biopsy confirmed acute GVHD (aGVHO). With tapering steroid therapy, aGvHD improved but she continued on 10mg prednisone daily.