Balato Anna, Lembo Serena, Cirillo Teresa, Megna Matteo, Raimondo Annunziata, Di Costanzo Luisa
Department of Dermatology, University of Naples Federico II, Naples, Italy.
Case Rep Dermatol. 2011 Mar 7;3(1):60-3. doi: 10.1159/000324344.
Psoriasis is a chronic immunologically-based inflammatory skin disease. B-chronic lymphocytic leukemia (B-CLL) is a form of leukemia characterized by the slow and progressive accumulation of monoclonal CD5+ B lymphocytes in peripheral blood, bone marrow, lymph nodes and other organs. A T-helper 1 cytokine-mediated pathway is involved in these disorders in which tumor necrosis factor-α (TNF-α) plays a central role. TNF-α is involved in physiological phenomena, such as host defense, inflammation and cell differentiation, and in many pathological conditions, such as fever and some malignant neoplasms. TNF-α involvement in psoriasis has been well validated by the clinical success of anti-TNF-α therapy. TNF-α has been well studied in the pathogenesis of B-CLL, suggesting it as a target in B-CLL therapy. We present the case of a patient suffering from plaque psoriasis and B-CLL. Since TNF-α is reported as a common link between psoriasis and B-CLL, the patient was treated with etanercept followed by infliximab, two anti-TNF-α drugs. During 3 years of therapy, the patient did not show significant modifications of lymphocyte levels, indicating no progression of B-CLL. We report this case to highlight the possibility to administer anti-TNF-α treatment in psoriatic patients affected by concomitant B-CLL.
银屑病是一种基于免疫的慢性炎症性皮肤病。B 细胞慢性淋巴细胞白血病（B-CLL）是白血病的一种形式，其特征是外周血、骨髓、淋巴结和其他器官中出现单克隆 CD5+ B 淋巴细胞的缓慢且进行性积累。一种辅助性 T 细胞 1 细胞因子介导的途径参与了这些疾病，其中肿瘤坏死因子-α（TNF-α）起着核心作用。TNF-α 参与诸如宿主防御、炎症和细胞分化等生理现象，以及许多病理状况，如发热和一些恶性肿瘤。TNF-α 在银屑病中的作用已通过抗 TNF-α 治疗的临床成功得到充分验证。TNF-α 在 B-CLL 的发病机制中也得到了充分研究，提示它可作为 B-CLL 治疗的一个靶点。我们报告了一例患有斑块状银屑病和 B-CLL 的患者。由于 TNF-α 被报道为银屑病和 B-CLL 之间的共同联系，该患者先后接受了两种抗 TNF-α 药物依那西普和英夫利昔单抗的治疗。在 3 年的治疗期间，患者的淋巴细胞水平未出现显著变化，表明 B-CLL 无进展。我们报告此病例以强调在患有 B-CLL 的银屑病患者中给予抗 TNF-α 治疗的可能性。
