Dermatologic complications in transplantation and cellular therapy for acute leukemia

Abstract

Adoptive cellular immunotherapy, mainly hematopoietic stem cell transplant and CAR-T cell therapy have revolutionized treatment of patients with acute leukemia. Indications and inclusion criteria for these treatments have expanded in recent years. While these therapies are associated with significant improvements in disease response and overall survival, patients may experience adverse events from associated chemotherapy conditioning, engraftment, cytokine storm, supportive medications, and post-transplant maintenance targeted therapies. Supportive oncodermatology is a growing specialty to manage cutaneous toxicities resulting from the anti-cancer therapies. In this review, we summarize diagnosis and management of the common cutaneous adverse events including drug eruptions, graft-versus-host disease, neoplastic and paraneoplastic complications in patients undergoing cellular therapies.

Keywords: CAR-T cell therapy; Dermatological complications; Drug eruptions; GVHD; Hematopoietic stem cell transplant.

Figure 1:

Toxic erythema of chemotherapy (TEC) in the groin.

Figure 2:

Painful rash secondary to cytarabine.

Figure 3:

Acute GVHD following alloSCT for AML.

Figure 4:

Early inflammatory phase of sclerodermoid GVHD (left), fully developed sclerodermoid GVHD complicated by progressive ulceration (right, top and bottom).

Figure 5:

Sweet’s syndrome in an AML patient on induction chemotherapy.

Figure 6:

Early stage of pyoderma gangrenosum (biopsy proven prior to deep ulceration) in a MDS patient on azacytdine (left) with relatively rapid resolution after 2 weeks on systemic steroid (right).

Figure 7:

Leukemia cutis as the first presenation in aucte monocytic leukemia.