title: Sirolimus as Long-term Graft-versus-host-disease Prophylaxis in Haploidentical Hematopoietic Stem Cell Transplant Recipients for Non-malignant Disorders is Associated with High Incidence of Acneiform Lesions.
abstract: BACKGROUND
  Sirolimus has provided the option for calcineurin inhibitor (CNI)-free immunosuppressive therapy in both solid organ transplant (SOT) and hematopoietic stem cell transplantation (HSCT). However, long-term use of sirolimus has been reported to be associated with a high incidence of cutaneous side effects in SOT, particularly acneiform lesions.
  
  
  METHODS
  We studied the incidence of acneiform lesions and the risk factors in 41 HSCT recipients between ages 4 and 64 years, undergoing HSCT for malignant (n = 29) and non-malignant diseases (n = 12) from haploidentical family donors.
  
  
  RESULTS
  Seven patients developed acneiform lesions at the median of 85 days (range, 45-105 days). Acneiform lesions occurred in 6/11 patients on sirolimus and in only 1/30 patients not receiving sirolimus (P = 0.001). This was more frequent in patients with non-malignant disorders (5/12 versus 2/29, P = 0.01) and those receiving graft from female donors (7/23 versus 0/18, P = 0.01).
  
  
  CONCLUSIONS
  Despite being frequently reported in SOT, this is the first such report in HSCT. Our study suggests that prolonged use of sirolimus might be associated with high incidence of acneiform lesions in haploidentical HSCT recipients with non-malignant diseases, particularly in those receiving graft from a female donor. We discuss the possible reasons for these findings and the putative mechanism of acneiform lesions in these patients.
authors.affiliation: Manashi Chakrabarti Foundation, Kolkata, India ; KPC Medical College and Hospital, Kolkata, India.
authors.forename: Aditi
authors.initials: A
authors.lastname: Chakrbarti
authors.affiliation: Manashi Chakrabarti Foundation, Kolkata, India ; Department of Blood and Marrow Transplantation, Dharamshila Hospital And Research Centre, New Delhi, India ; Apollo Gleneagles Hospital, Kolkata, India.
authors.forename: Sarita Rani
authors.initials: SR
authors.lastname: Jaiswal
authors.affiliation: Manashi Chakrabarti Foundation, Kolkata, India ; Department of Blood and Marrow Transplantation, Dharamshila Hospital And Research Centre, New Delhi, India.
authors.forename: Suparno
authors.initials: S
authors.lastname: Chakrabarti
keywords: Acneiform lesions; HSCT; aplastic anemia; haploidentical; sirolimus