Summary:We report two cases of severe leg ulcerations in patients being treated with thalidomide for graft-versus-host disease following bone marrow transplantation. Local wound care and debridement were attempted, but one patient required skin grafting to ensure healing. We propose that this complication may be due to the antiangiogenic properties of thalidomide and urge careful attention to skin breakdown in patients being treated with this compound. Bone Marrow Transplantation (2001) 27, 229-230. Keywords: thalidomide; skin; ulceration; transplant; GVHD Case reports Patient 1A 47-year-old man with progressive B cell chronic lymphocytic leukemia (CLL) originally treated with fludarabine, prednisone, danozol, leukeran, cytoxan, vincristine and dexamethasone underwent an allogeneic bone marrow transplant with busulfan/cytoxan conditioning in February 1996. On day 28 he developed total body erythema with some skin desquamation which resolved following treatment with methylprednisolone and cyclosporine. On day 73 staphylococcal A immunopheresis was utilized to treat severe immune thrombocytopenic purpura due to an auto-antibody. By day 98 this had resolved following six aphereses. His skin was still dry at this time, but no longer flaking. By day 400 his CLL was in full remission. His skin was lichenified in areas of his torso but no sclerodermatous changes were noted. His immunosuppressives were stopped on day 500. On day 510 he was doing well with some thickened skin and scaling over his hands and knuckles. Two weeks after stopping the immunosuppressives, his skin
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