Resolution of psoriasis after allogeneic bone marrow transplantation for chronic myelogenous leukemia: late complications of therapy

Abstract

Summary:Treatment of autoimmune disease with bone marrow transplantation (BMT) is under investigation. A few reports of patients undergoing allogeneic BMT for malignant conditions observed the resolution of psoriasis after BMT, with minimal late morbidity. We describe a patient with chronic myelogenous leukemia (CML) whose psoriasis resolved completely after allogeneic BMT. However, the patient's course was complicated by extensive chronic graft-versus-host disease (GVHD), recurrent serious infections, poor performance status and quality of life, and severe disability. The patient died 887 days post transplant due to infectious complications. The potential benefits and risks of treatment of autoimmune diseases with allogeneic BMT are discussed. Bone Marrow Transplantation (2000) 26, 1239-1241. Keywords: autoimmunity; psoriasis; bone marrow transplantation Psoriasis is one of the most common dermatologic diseases, affecting more than six million people in the United States and up to 2% of the world's population. 1 Psoriasis is a chronic inflammatory disease exhibiting a wide spectrum of clinical signs ranging from variable skin manifestations to debilitating arthritis. Disease affecting younger patients is generally more severe and recurrent. Treatment strategies include the use of a combination of emollients, corticosteroids, vitamin-D analogues, cyclosporine, tar preparations, dithranol, PUVA and retinoids.Psoriasis is an immune-mediated disease. Activated CD4 + and CD8 + lymphocytes infiltrate the dermis and epidermis, resulting in hyperkeratosis, parakeratosis, epidermal acanthosis and elongation of rete ridges, and vascular dilatation. oid compartment and infusion of allogeneic bone marrow is a treatment strategy which may have curative potential. Indeed, in animal models, allogeneic (and autologous) BMT has been shown to favorably alter the course of certain immune-mediated diseases. 3 Also, several clinical case reports demonstrated durable resolution of psoriasis after allogeneic BMT performed for concurrent malignant conditions. 4-8 These reports did not observe significant late procedure-related morbidity.In this report, we describe a patient with long-standing, extensive psoriasis poorly responsive to conventional treatments which resolved completely through 2.4 years of follow-up after an allogeneic BMT, performed for the diagnosis of CML. This case report demonstrates that long-term remission of immune-mediated diseases can occur with allogeneic BMT, but also illustrates the potentially serious risks associated with the application of this treatment strategy to patients with autoimmune diseases. Case reportA 55-year-old woman underwent allogeneic BMT in 1996, 4 months following a diagnosis of CML. The bone marrow donor was her healthy HLA matched brother. The patient also had a history of long-standing severe erythrodermic psoriasis for 33 years, which manifested as typical, well demarcated erythematous scaling plaques, symmetrically distributed over the elbows, knees, trunk and buttocks. During the ...

Resolution of psoriasis following allogeneic bone marrow transplantation for chronic myelogenous leukemia: Case report and review of the literature

“…Some patients with coincidental autoimmune disorder who underwent allogeneic BMT for a malignancy have been cured of their autoimmune disease [4][5][6][7][8][9]; however, allogeneic BMT is not routinely considered for treatment of autoimmune disease because of its significant mortality and morbidity. In this paper, we have described a patient with CML whose psoriasis resolved completely following allogeneic BMT, and reviewed similar cases [4,5,[7][8][9][10][11] (Table I).…”

“…In this paper, we have described a patient with CML whose psoriasis resolved completely following allogeneic BMT, and reviewed similar cases [4,5,[7][8][9][10][11] (Table I).…”

“…Therefore, it has been suspected that the course of autoimmune disease can be modified by allogeneic BMT. Recently, the resolution of coincidental immunemediated diseases following BMT has been reported [4][5][6][7][8][9]. In the present report, we describe a patient with chronic myelogenous leukemia (CML) whose psoriasis resolved completely over 2.5 years of follow-up period after allogeneic BMT.…”

Induction of graft-versus-autoimmune (GVA) disease effect against refractory psoriasis by complete donor-type chimerism and graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

“…7,11 Significant acute and chronic GVHD in CST can lead to the durable remission of psoriasis, but may also cause the death of patients. Severe, sometimes lethal, GVHD, or the introduction of another immune dysfunction to HSCT recipients, should be avoided in the treatment of benign autoimmune disorders.…”

Alopecia areata after HLA-identical BMT from an affected, sibling donor

“…The onset of alopecia areata post allo-SCT lends support to a T-cell-mediated pathogenesis, suggesting that it may be immunologically mediated by the means of transmission from stem cell donor to recipient. 2,5,6 Other causes of alopecia areata were eliminated as the patient's thyroid function tests were normal, the antinuclear and antiSjogren's Abs were negative and the liver biopsy for elevated transaminases was negative for GVHD.…”