Fred Hutchinson Cancer Research Center, Seattle, Washington.
University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington.
Transplant Cell Ther. 2021 Nov;27(11):951.e1-951.e6. doi: 10.1016/j.jtct.2021.07.022. Epub 2021 Jul 29.
We have consistently noticed in our clinical practice eczematous dermatitis (EcD) without other pathologic findings of graft-versus-host disease (GVHD) in recipients of unrelated cord blood transplantation (CBT). We hypothesized that the incidence of EcD was higher in CBT compared with other donor types, and our objective in this study was to compare the frequency, clinical course, and response to therapy of EcD between CBT and non-CBT recipients. We conducted a retrospective study of 720 consecutive adult recipients of allogeneic hematopoietic cell transplants from 2010 to 2016 from any donor type and with follow-up for at least 1 year after transplantation. After using keyword-based automated scanning to identify "eczema," "dermatitis," or "spongiosis" terms in medical records, we retrieved 217 cases for manual record review. We identified 23 EcD cases (12 in CBT recipients and 11 in patients with other types of donors) with a median onset at 8 months after transplantation. The 2-year cumulative incidence of EcD was 20% (95% confidence interval [CI], 11.2% to 31.5%) after CBT and 1.7% (95% CI, .90% to 2.90%) with other types of donors (P < .0001). Fifteen cases had a skin biopsy without distinctive pathologic features of GVHD. The most common EcD-involved sites in CBT recipients were face (75%), neck (50%), and antecubital fossae (50%). Compared with patients with other types of donors, EcD after CBT was more likely to involve three or more sites (10 of 12 vs. 2 of 10; P = .008) and had a more protracted course (lasting >6 months in 6 of 58 vs. 1 of 661; P < .0001). In both groups, EcD responded to topical therapy, and only a few cases required systemic therapy. EcD is a relatively frequent skin condition among recipients of unrelated CBT. Irrespective of donor type, most cases of EcD can be successfully managed with only topical therapy. These findings will help providers recognize EcD, avoid potentially harmful systemic therapy, and better counsel transplant recipients.
在我们的临床实践中，我们一直注意到，在接受无关脐带血移植（CBT）的患者中，出现了没有移植物抗宿主病（GVHD）其他病理表现的湿疹性皮炎（EcD）。我们假设 CBT 中 EcD 的发生率高于其他供体类型，我们的研究目的是比较 CBT 和非 CBT 受者之间 EcD 的频率、临床过程和治疗反应。我们对 2010 年至 2016 年间接受同种异体造血细胞移植的 720 例连续成年患者进行了回顾性研究，这些患者来自任何供体类型，且移植后至少随访 1 年。在使用基于关键字的自动扫描方法在病历中识别“湿疹”、“皮炎”或“海绵形成”等术语后，我们对 217 例病例进行了手动记录审查。我们确定了 23 例 EcD 病例（CBT 受者 12 例，其他供体类型患者 11 例），中位发病时间为移植后 8 个月。CBT 后 2 年 EcD 的累积发生率为 20%（95%置信区间 [CI]，11.2%至 31.5%），而其他供体类型的发生率为 1.7%（95% CI，.90%至 2.90%）（P<.0001）。15 例皮肤活检无明显 GVHD 病理特征。CBT 受者中最常见的 EcD 受累部位为面部（75%）、颈部（50%）和肘前窝（50%）。与其他供体类型的患者相比，CBT 后 EcD 更有可能累及三个或更多部位（12 例中有 10 例 vs. 10 例中有 2 例；P=.008），且病程更长（58 例中有 6 例持续>6 个月 vs. 661 例中有 1 例；P<.0001）。在两组中，EcD 均对局部治疗有反应，仅少数病例需要全身治疗。EcD 是接受无关 CBT 的患者中一种相对常见的皮肤疾病。无论供体类型如何，大多数 EcD 病例仅用局部治疗即可成功治疗。这些发现将有助于提供者识别 EcD，避免潜在的有害全身治疗，并更好地为移植受者提供咨询。
