Td. Horn et al., ERYTHRODERMA AFTER AUTOLOGOUS BONE-MARROW TRANSPLANTATION MODIFIED BYADMINISTRATION OF CYCLOSPORINE AND INTERFERON-GAMMA FOR BREAST-CANCER, Journal of the American Academy of Dermatology, 34(3), 1996, pp. 413-417
Background: Allogeneic graft-versus-host disease is associated with de
creased rates of tumor relapse. The addition of interferon gamma to cy
closporine, given to induce graft-versus-host disease after autologous
bone marrow transplantation, increases the extent of the cutaneous er
uption. Objective: Our purpose was to describe the clinical and histol
ogic cutaneous changes in 10 patients with breast cancer who received
interferon gamma to potentiate graft-versus-host disease after autolog
ous bone marrow transplantation modified by cyclosporine. Methods: Ten
women receiving autologous bone marrow transplantation modified by th
e administration of cyclosporine and interferon gamma were observed cl
inically with sequential biopsy of the skin weekly and at the time of
cutaneous eruptions. Results: Erythroderma (stage 3) developed in five
women after the first or second administration of interferon gamma. A
t least one skin biopsy specimen from 7 of the 10 women showed grade 2
changes of graft-versus-host reaction, including all patients with er
ythroderma. Epidermal intercellular edema was prominent in these speci
mens with expression of keratinocyte HLA-DR and intercellular adhesion
molecule 1. Induction of keratinocyte HLA-DR and intercellular adhesi
on molecule 1 expression was not observed in specimens from normal ski
n during administration of interferon gamma. Conclusion: This protocol
causes a more widely distributed cutaneous eruption, including erythr
oderma (50%), than autologous bone man;ow transplantation and cyclospo
rine administration alone (3%). Whether it will affect survival is unk
nown.