Cutaneous graft-versus-host disease after proton-based craniospinal irradiation for recurrent Philadelphia-positive acute lymphoblastic leukaemia.
Treatment of recurrent acute lymphoblastic leukaemia (ALL) often involves allogeneic stem-cell transplantation (alloSCT) and disease recurrence in the central nervous system may require craniospinal irradiation. Although graft-versus-host disease (GVHD) is a known risk after alloSCT, cutaneous manifestation within radiation fields is rarely seen. The authors report a case of a 25-year-old man with Philadelphia+ALL recurring in the central nervous system after a homologous SCT. Craniospinal radiation was delivered with proton therapy to a total dose of 24 cobalt-Gray-equivalents in 12 fractions. Eight weeks after the proton therapy, significant cutaneous GVHD had developed within the radiation fields. This was treated successfully with tacrolimus (4 mg/day), a short course of methylprednisolone, and topical treatment with 0.1% triamcinolone cream, 0.05% clobetasol ointment. Cutaneous GVHD after SCT can be seen within proton radiation fields probably due to an inherent higher skin dose.
Radiation Oncology, UT MD Anderson Cancer Center, Houston, Texas, USA.
Hadley
H
Sharp
David
D
Grosshans
Tapan
T
Kadia
Bouthaina Shbib
BS
Dabaja
D001706:Biopsy; D061888:Craniospinal Irradiation / Q000009:adverse effects* / Q000379:methods; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D061766:Proton Therapy / Q000009:adverse effects*; D011832:Radiation Injuries / Q000150:complications* / Q000175:diagnosis; D012867:Skin / Q000473:pathology / Q000528:radiation effects; D012871:Skin Diseases / Q000175:diagnosis / Q000209:etiology*; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D055815:Young Adult