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Resolution of atopic dermatitis following allogeneic bone marrow transplantation for chronic myelogenous leukemia

Bone Marrow Transplantation volume 35, pages 1223–1224 (2005)Cite this article

Atopic dermatitis is a complex, multifactorial, cutaneous manifestation of the atopic diathesis.1 A wide range of cell-mediated immune defects associated with T-lymphocytes have been reported in atopic dermatitis.2 Recently, some patients with coincidental autoimmune disease who underwent allogeneic bone marrow transplantation (BMT) for a malignancy have been cured of their autoimmune disease.3, 4, 5, 6 We describe a patient with chronic myelogenous leukemia (CML) whose atopic dermatitis resolved completely over a 4-year follow-up period, after allogeneic BMT.

A 33-year-old man with CML was transferred to our hospital in October 2000 for BMT. He had been treated with interferon-α and hydroxyurea for 2 years, but there was no cytogenetic response. He had suffered from atopic dermatitis for 20 years and had been treated with topical corticosteroids. His skin lesions were moderate and constant, and he had no respiratory problems. He underwent an allogeneic BMT with marrow donated from an unrelated HLA-identical woman, in November 2000. The donor had no medical history of atopy. Pre-transplant conditioning consisted of thiotepa (days −8 and −7; 200 mg/m2/day), cyclophosphamide (days −6 and −5; 2250 mg/m2/day), and fractionated total body irradiation (days −4 to −1; 3 Gy/day). He received graft-versus-host disease (GVHD) prophylaxis with methotrexate (day 1, 10 mg/m2/day; and days 3, 6, and 11, 6 mg/m2/day) and tacrolimus (0.03 mg/kg/day) as a continuous infusion. He also received 300 μg/day granulocyte colony-stimulating factor by continuous infusion, beginning on day 1, to aid granulocyte recovery. Bone marrow engraftment was successful, and complete chimerism was confirmed by fluorescence in situ hybridization analysis using X- and Y-chromosome probes. He complained of painful palmoplantar erythema on day 11. This was confirmed as acute GVHD (grade I) by skin biopsy. Treatment with prednisolone was begun on day 35 to relieve the pain, although the skin lesion was limited. On day 65 after BMT, he developed Epstein–Barr viral meningitis, but this resolved with discontinuation of tacrolimus and administration of an antiviral agent and immunoglobulin. Furthermore, he developed bronchiolitis obliterans organizing pneumonia 4 months after BMT. His atopic dermatitis resolved around day 70 post transplant. His serum IgE level was 3130 mg/dl pre-transplant and this decreased to 212 mg/dl on day 125. His CML remains in remission and he has been free of atopic dermatitis for 4 years post transplant, despite discontinuation of immunosuppressive treatment.

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  1. Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    H Koharazawa, H Kanamori, M Takabayashi, S Yamaji, J Taguchi, K Fujimaki & Y Ishigatsubo

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  1. H Koharazawa
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  2. H Kanamori
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  3. M Takabayashi
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  4. S Yamaji
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  5. J Taguchi
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  6. K Fujimaki
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  7. Y Ishigatsubo
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Koharazawa, H., Kanamori, H., Takabayashi, M. et al. Resolution of atopic dermatitis following allogeneic bone marrow transplantation for chronic myelogenous leukemia. Bone Marrow Transplant 35, 1223–1224 (2005). https://doi.org/10.1038/sj.bmt.1704990

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