Thiotepa-induced cutaneous toxicity in pediatric patients: Case report and implementation of preventive care guidelines

Abstract

Thiotepa, a highly lipophilic, alkylating agent, and/or its active metabolites may be excreted in part via skin in patients receiving high-dose therapy. We present a case of cutaneous toxicity observed in a 4.5-year-old girl patient with medulloblastoma treated with a high-dose thiotepa conditioning regimen before autologous stem cell transplantation. Skin lesions, as well as their pattern and locations, were evocative of thiotepa toxidermia. After the case herein described, preventive care guidelines were implemented in our unit as from 2014. A retrospective follow-up of 26 pediatric patients receiving thiotepa prior to stem cell transplantation was performed until March 2018. In this series of patients, only one patient experienced cutaneous toxicity as reported herein. Thereafter, only mild cutaneous toxicity was observed, even with double or triple transplantation protocols with high-dose thiotepa. Clear preventive care instructions should be detailed in the Summary of Product Characteristics in order to minimize the cutaneous toxicity of thiotepa.

Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains

“…3 ). Since showering is recommended for patients receiving Thiotepa treatment (due to excretion of metabolites through the skin) ( 19 ), complete suspension of shower use was not possible. Therefore, sink decontamination was changed back to acetic acid, and removable and autoclavable shower inserts were installed additionally, to avoid backsplash by shifting the position of the shower drain and water trap ( Fig.…”

“…Thiotepa, a lipophilic alkylating agent for cancer treatment, or its active metabolites can be excreted via the skin and cause cutaneous toxicities. Regular removal by showering or bathing is thus indicated ( 19 , 33 ). Water-free washing may not be enough to remove the toxic residuals and prevent accumulation in the skin ( 19 ).…”

“…Regular removal by showering or bathing is thus indicated ( 19 , 33 ). Water-free washing may not be enough to remove the toxic residuals and prevent accumulation in the skin ( 19 ). Therefore, as a remedial action, our aim was to decontaminate the bacterial reservoir in the drainage system.…”

Acute conditions in dermatology: toxic reactions and their treatment

“…Есть несколько типов токсидермий, которые различаются по причине их уникальных клинических проявлений [8][9][10] Термин «эритродермия» (эксфолиативный дерматит) впервые ввел Фон Хебра в 1868 г. Эритродермия проявляется диффузной эритемой и шелушением более 90% поверхности тела. Это реакция и кожное проявление множества основ ных заболеваний, включая псориаз и экзему, или реакция на прием определенных лекарств.…”

Decreasing Skin Breakdown Around Central Lines in Patients Receiving Thiotepa Prior to Bone Marrow Transplantation

“…Thiotepa has improved the rates of engraftment and quickened neutrophil recovery in both children and adults when used in a combination of conditioning regimes (Sanz et al, 2012). Thiotepa, a highly lipophilic and alkylating agent, excretes active metabolites through the patient’s skin (Schandevyl & Bauters, 2018) leaving them at risk of skin toxicity and breakdown. Skin toxicity is manifested by skin discoloration, pruritus, blistering, desquamation, and peeling, which may be more severe in skin folds and under dressings such as central lines.…”