Diagnosis and treatrnent of psoriasiform cutaneous chronic graft versus host disease and literatures review

Objective To explore the treatment and clinical therapeutic effect of psoriasiform cutaneous chronic graft versus host disease (cGVHD) in a patient with hybrid acute leukemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods On 9 April 2014, one case with hybrid acute leukemia who was treated with allo-HSCT in Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, was selected as the research object. The conditioning regimen before allo-HSCT included idarubicin, cytosine arabinoside, busulfan, anti-thymocyte globulin and cyclophosphamide (CTX). The source of grafts was a combination of peripheral blood hematopoietic stem cells and bone marrow hematopoietic stem cells from human leukocyte antigen(HLA) haploidentical donor.The recipients received cyclosporin A, mycophenolate mofetil (MMF) and short-term methotrexate (MTX) for GVHD prophylaxis. Results Engraftment time was 17 d after allo-HSCT. Twenty-seven days and 7 months after allo-HSCT [34 d after donor lymphocyte infusion(DLI)], grade Ⅰ skin acute graft-versus-host disease (aGVHD) were occurred respectively, and both treated with methylprednisolone (MP) and cyclosporine A. One year after allo-HSCT, skin rash occurred on patient′s skin of the upper limbs, chest and abdomen. The patient was diagnosed with psoriasiform cutaneous cGVHD. After treatment with MP, CTX and cyclosporine A, the patient′s symptoms were relieved. Conclusions Hybrid acute leukemia patients with psoriasiform cutaneous cGVHD after allo-HSCT is rare. The usage of low-dose CTX combined with glucocorticoids and cyclosporine A can obtain better therapeutic effects. Key words: Hematopoietic stem cell transplantation; Graft vs host disease; Parapsoriasis; Leukemia, biphenotypic, acute; Skin diseases