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Complete resolution of guttate psoriasis following autologous SCT for Ewing’s sarcoma in a pediatric patient

Bone Marrow Transplantation volume 47, pages 1585–1586 (2012)Cite this article

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Psoriasis is a chronic, inflammatory autoimmune disorder primarily affecting the skin and joints. Management strategies are based on the classification, area of involvement and severity of the condition as well as patient comorbidities. The continued development of various immunosuppressives and targeted biological agents has provided additional therapeutic options although with significant complications.1 For this reason, alternative treatment strategies have been proposed including hematopoietic SCT (HSCT). A consensus statement published in 1997 from the European League against Rheumatism (EULAR) and the European Group for Blood and Marrow Transplantation (EBMT) recommended that autologous granulocyte colony-stimulating factor (G-CSF) peripheral stem cell-mobilized HSCT is relatively safe and should be considered for severe autoimmune disorders with increased risk of mortality, and before any irreversible organ damage takes place.2 Seven years after the EULAR/EBMT position statement, almost 800 patients were documented within the European and North American databases, the majority were treated with autologous HSCT.3 In a 10-year experience in a single institution, Gualandi et al. reported the outcomes of 32 patients that received autologous HSCT for a variety of severe autoimmune disorders. The majority received CY/G-CSF-mobilized peripheral CD34+ stem cells. Two different preparative regimens were used, a myeloablative regimen that included BEAM (carmustine, etoposide, cytarabine, and melphalan) with or without antithymocyte globulin, or a reduced intensity regimen that included thiotepa and CY. The 10-year overall survival for all the patients was 97% and freedom from relapse of any kind was 66% at 8 years.4

Information specifically related to HSCT in management of psoriatic disorders remains limited. A thorough literature review resulted in a few case reports, all in adult patients. In two case reports, two patients received myeloablative conditioning and ASCR, and this resulted in long term resolution of severe and chronic psoriatic-arthritis conditions.5, 6 One of the two patients continued to be in long-term remission5 whereas the other had a mild clinical relapse 16 months following the transplant.6 Three additional patients included within a review article achieved remission ranging 8–22 months.3 A potential advantage following allogeneic HSCT is graft versus autoimmunity (GVI), which may eliminate self-reactive lymphocytes and host stem cells leading to the control of psoriatic arthritis.3, 7, 8, 9 One case report discussed a patient with chronic myelogenous leukemia (CML) and severe psoriatic arthritis that showed a short-lived response of both diseases following non-myeloablative SCT, though both the diseases recurred shortly following the therapy. However, a longer and more permanent response of both the diseases for up to three years was successfully achieved by withdrawing graft versus host disease (GVHD) prophylaxis with CYA and the activation of alloreactive T-cells resulting in clinical GVHD. A similar possible GVI effect has also been previously reported by Snowden et al. In this report, three patients with rheumatoid arthritis and one with psoriatic arthritis received allogeneic SCT with subsequent GVHD that could have resulted in an added GVI effect. Unfortunately, the effect in the patient with psoriasis and CML was short-lived. Unlike the patient with psoriasis described earlier, this patient did not develop GVHD.7

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References

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Authors and Affiliations

  1. Pharmacy Department, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA

    K Held

  2. Bone Marrow Transplant Section, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA

    R Rahmetulla & M A Radhi

  3. Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA,

    T W Loew

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  1. K Held
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  2. R Rahmetulla
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  3. T W Loew
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  4. M A Radhi
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Correspondence to K Held.

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Held, K., Rahmetulla, R., Loew, T. et al. Complete resolution of guttate psoriasis following autologous SCT for Ewing’s sarcoma in a pediatric patient. Bone Marrow Transplant 47, 1585–1586 (2012). https://doi.org/10.1038/bmt.2012.68

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