ERYTHRODERMA AFTER AUTOLOGOUS BONE-MARROW TRANSPLANTATION MODIFIED BYADMINISTRATION OF CYCLOSPORINE AND INTERFERON-GAMMA FOR BREAST-CANCER

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.