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Markers of systemic involvement and death in hospitalized cancer patients with severe cutaneous adverse reactions - 11/02/19

Doi : 10.1016/j.jaad.2018.10.039 
Shoko Mori, BS a, b, Alanna Hickey, BA c, Stephen W. Dusza, DrPH a, Mario E. Lacouture, MD a, d, Alina Markova, MD a, d,
a Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York 
b SUNY Downstate College of Medicine, Brooklyn, New York 
c University of Massachusetts Medical School, Worcester, Massachusetts 
d Department of Dermatology, Weill Cornell Medical College, New York, New York 

Correspondence to: Alina Markova, MD, Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 E 60th St, New York, NY 10022.Dermatology ServiceMemorial Sloan Kettering Cancer Center16 E 60th StNew YorkNY10022

Abstract

Background

Severe cutaneous adverse reactions (SCARs) are frequent in inpatient oncology. Early intervention might reduce morbidity, mortality, and hospitalization costs; however, current clinical and histologic features are unreliable SCAR predictors. There is a need to identify rational markers of SCARs that could lead to effective therapeutic interventions.

Objective

To characterize the clinical and serologic features of hospitalized patients with cancer who developed SCARs.

Methods

Retrospective review of 49 hospitalized cancer patients with a morbilliform rash, recorded testing for serum cytokines (interleukin [IL] 6, IL-10, and tumor necrosis factor [TNF] α) or elafin, and a prior dermatology consultation. Patients were categorized as having a simple morbilliform rash without systemic involvement or complex morbilliform rash with systemic involvement.

Results

Fifteen out of 49 patients (30.6%) were deceased at 6 months from time of dermatologic consultation. Elafin, IL-6, and TNF-α were significantly higher in patients who died compared with patients who were still alive at 6 months. IL-6 and IL-10 were significantly higher in patients with a drug-related complex rash.

Limitations

Retrospective design, limited sample size, and high-risk patient population.

Conclusion

In cancer patients with SCARs, elafin, IL-6, and TNF-α levels might predict a poor outcome. Agents directed against these targets might represent rational treatments for the prevention of fatal SCARs.

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Key words : cytokine, drug-induced hypersensitivity syndrome, drug rash, drug reaction, drug reaction with eosinophilia and systemic symptoms, graft versus host disease, severe cutaneous adverse reaction

Abbreviations used : AGEP, DIHS, DRESS, GVHD, IL, NLR, SCAR, SJS, TEN, TNF-α


Plan


 Funding sources: Dr Markova is supported by a Dermatology Foundation Career Development Award. This study was supported in part by a grant from the National Cancer Institute, National Institutes of Health, given to the Memorial Sloan Kettering Cancer Center (P30-CA008748).
 Disclosures: Dr Lacouture reported receiving research funding from Berg, Bristol-Myers Squibb, Lutris, Paxman, Novocure, Veloce, and US Biotest and serving as a consultant to Legacy Healthcare Services, Adgero Bio Pharmaceuticals, Amryt Pharmaceuticals, Celldex Therapeutics, Debiopharm, Galderma Research and Development, Johnson and Johnson, Novocure Inc, Lindi, Merck, Sharp and Dohme Corporation, Helsinn Healthcare SA, Janssen Research & Development, LLC, Menlo Therapeutics, Novartis Pharmaceuticals Corporation, F. Hoffmann-La Roche AG, Abbvie, Inc, Boehringer, Ingelheim Pharma Gmbh & Co. KG, Allergan Inc, Amgen Inc, E.R. Squibb & Sons, L.L.C., EMD Serono, Inc, Astrazeneca Pharmceuticals LP, Genentech, Inc, Leo Pharma, Inc, Seattle Genetics, Bayer, Manner SAS, Lutris, Pierre Fabre, Paxman Coolers, Adjucare, Dignitana, Biotechspert, Teva Mexico, Parexel, OnQuality Pharmaceuticals Ltd, Novartis, and Our Brain Bank. Dr Markova reported serving as a consultant to AstraZeneca. No other potential conflicts of interest were disclosed.
 Reprints not available from the authors.


© 2018  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 80 - N° 3

P. 608-616 - mars 2019 Retour au numéro
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