Toxic erythema of chemotherapy following i.v. BU plus fludarabine for allogeneic PBSC transplant

Abstract

I.v. BU plus fludarabine is an effective conditioning regimen for myeloid neoplasias with low treatment-related mortality. At standard doses, cutaneous toxicity has been reported in o5% of cases. As we observed a much higher incidence of cutaneous toxicity in patients who received predominantly pharmacokinetically based doses of BU, we performed a retrospective analysis of 61 patients who received i.v. BU plus fludarabine ( þ / À antithymocyte globulin; ATG) as a conditioning regimen before allogeneic PBSC transplant. Of the 58 evaluable patients, 33 (57%) developed cutaneous toxicity that fell within the spectrum of toxic erythema of chemotherapy (TEC). The median onset of TEC was 22 days and most patients had multiple sites of involvement, with the groin, axillae and palms/soles being the favored sites. In men, scrotal involvement, sometimes severe, was also commonly observed. Initially, allergic reactions to antibiotics, fungal infections and GVHD were also considered until the clinical presentation of TEC became well recognized. In all patients, the skin healed without specific therapy but resolution often required several weeks. This series suggests that TEC is common after BU/fludarabine þ / À ATG and it is important for transplant physicians to recognize, particularly as misdiagnosis could lead to inappropriate treatment.

Cutaneous Adverse Effects Associated With the Tyrosine-Kinase Inhibitor Cabozantinib

“…45,47 Painful scrotal erythema can also be seen in the setting of traditional chemotherapeutic drugs, which, together with erythematous involvement of the hands, feet, and other intertriginous areas, constitute a spectrum of chemotherapy-associated cutaneous toxic effects termed toxic erythema of chemotherapy. 51 Three patients in our cohort reported both scrotal symptoms and HFSR, but the lack of involvement of the inguinal creases and other intertriginous areas suggests a slightly altered presentation compared with classic toxic erythema of chemotherapy. It is also possible that commonly seen pelvic lymphadenopathy leading to scrotal, pelvic, or lower extremity edema may have contributed to the relatively high incidence of scrotal symptoms in the present study.…”

Drugs as a Frequent Cause of Acute Rash in Patients after CD34+-Selected Peripheral Blood Stem Cell Transplantation

“…The leading cause of a non-aGVHD rash in our CD34 +selected allo-HSCT recipients with a clear etiology was drug eruption. Patients who undergo allo-HSCT are at an increased risk of developing drug hypersensitivity reactions (eg, exanthematous eruptions, characterized by a morbilliform or maculopapular rash), as well as drug toxicity reactions (eg, toxic erythema of chemotherapy) with intertriginous prominence and acral erythema [2,[26][27][28][29][30]. Cytotoxic agents and antibiotics are common culprits of drug rash in allo-HSCT recipients [2,26].…”

Malignant intertrigo: A subset of toxic erythema of chemotherapy requiring recognition

“…In contrast to PPE, intertriginous involvement continues to be frequently misdiagnosed, resulting in hospitalization, inappropriate treatments, and inaccurate labeling of drug allergies,1, 2 as in the cases described in this report. As awareness of TEC increases, the rate of dermatologic consultations and biopsies decreases 3 . As such, characterization of the manifestations of TEC is paramount for prompt, accurate diagnosis and treatment and to avoid invasive procedures (eg, biopsies) and inappropriate pharmacotherapy.…”