Erythroderma after autologous bone marrow transplantation modified by administration of cyclosporine and interferon gamma for breast cancer.
BACKGROUND
Allogeneic graft-versus-host disease is associated with decreased rates of tumor relapse. The addition of interferon gamma to cyclosporine, given to induce graft-versus-host disease after autologous bone marrow transplantation, increases the extent of the cutaneous eruption.


OBJECTIVE
Our purpose was to describe the clinical and histologic cutaneous changes in 10 patients with breast cancer who received interferon gamma to potentiate graft-versus-host disease after autologous bone marrow transplantation modified by cyclosporine.


METHODS
Ten women receiving autologous bone marrow transplantation modified by the administration of cyclosporine and interferon gamma were observed clinically 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. At least on skin biopsy specimen from 7 of the 10 women showed grade 2 changes of graft-versus-host reaction, including all patients with erythroderma. Epidermal intercellular edema was prominent in these specimens with expression of keratinocyte HLA-DR and intercellular adhesion molecule 1. Induction of keratinocyte HLA-DR and intercellular adhesion molecule 1 expression was not observed in specimens from normal skin during administration of interferon gamma.


CONCLUSIONS
This protocol causes a more widely distributed cutaneous eruption, including erythroderma (50%), than autologous bone marrow transplantation and cyclosporine administration alone (3%). Whether it will affect survival is unknown.
Horn
T D
TD
Department of Dermatology, The Johns Hopskins Medical Institutions, Baltimore, MD 21287, USA.
Altomonte
V
V
Vogelsang
G
G
Kennedy
M J
MJ
D000328:Adult; D016026:Bone Marrow Transplantation; D001943:Breast Neoplasms / Q000276:immunology / Q000628:therapy*; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D003873:Dermatitis, Exfoliative / Q000276:immunology / Q000473:pathology*; D004487:Edema / Q000473:pathology; D004817:Epidermis / Q000473:pathology; D005260:Female; D005786:Gene Expression Regulation; D006086:Graft vs Host Disease / Q000276:immunology / Q000473:pathology; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis; D007371:Interferon-gamma / Q000008:administration & dosage / Q000627:therapeutic use*; D015603:Keratinocytes / Q000276:immunology; D015996:Survival Rate
D006684:HLA-DR Antigens; D018799:Intercellular Adhesion Molecule-1; D007371:Interferon-gamma; D016572:Cyclosporine