RESUMO
Abstract Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplants (allo-HSCT) associated with significant morbidity and mortality. The earliest and most common manifestation is cutaneous graft-versus-host disease. This review focuses on the pathophysiology, clinical features, prevention and treatment of cutaneous graft-versus-host disease. We discuss various insights into the disease's mechanisms and the different treatments for acute and chronic skin graft-versus-host disease.
Assuntos
Humanos , Dermatopatias/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Doença Enxerto-Hospedeiro/etiologia , Dermatopatias/terapia , Doença Crônica , Fotoferese/métodos , Exantema/etiologia , Exantema/terapia , Glucocorticoides/uso terapêutico , Doença Enxerto-Hospedeiro/terapiaRESUMO
Sézary syndrome (SS) is an unusually aggressive T- cell lymphoma characterized by the triad of erythroderma, the presence of more than 1,000 Sézary cells in peripheral blood and lymphadenopathies. It is accompanied by generalized pruritus and poor quality of life. The management of SS depends on its stage, patient comorbidities, and treatment availability. Extracorporeal photopheresis (ECP) is the first line of treatment for patients with T-cell lymphomas in stage IVA1, IVA2 or SS. This treatment comprises three phases: leukapheresis, photoactivation and subsequent reinfusion of lymphocytes. As it is an immunomodulatory therapy it does not produce generalized immunosuppression. We report a 76 year-old male with SS stage IIIb initially treated with 12 sessions of ultraviolet phototherapy without response. After 10 well-tolerated sessions of ECP, itching and skin lesions eventually disappeared.
Assuntos
Idoso , Humanos , Masculino , Fotoferese/métodos , Síndrome de Sézary/terapia , Neoplasias Cutâneas/terapia , Biópsia , Fibroblastos/patologia , Citometria de Fluxo , Prurido/patologia , Indução de Remissão/métodos , Síndrome de Sézary/patologia , Neoplasias Cutâneas/patologiaRESUMO
El reconocimiento de la participación de mecanismos inmunológicos en la fisiopatología de muchas enfermedades ha estimulado el desarrollo de nuevas estrategias terapéuticas de inmunointervención como la fotoféresis, la radioféresis y la vacunación con células dendríticas. Las observaciones clínicas han mostrado efectos positivos y resultados alentadores en la utilización de estas terapias