calcipotriene and Acute-Disease

Skin graft versus host disease (GVHD) can affect quality of life in hematopoietic stem cell transplant recipients. Therapeutic options for steroid-refractory GVHD are limited. We report the first prospective pilot study evaluating the topical vitamin D3 analog Calcipotriene (DOVONEX 0.005% cream) for acute skin GVHD in children, with associated analyses of target organ chemokine CXCL10 changes in response to therapy. We observed that Calcipotriene applications were safe and well tolerated. There were no symptom progression nor new symptoms requiring GVHD therapy escalation during study period. The most consistent response observed by study subjects was resolution of pruritus in eight patients and significant improvement in pruritus in two study subjects. Nine of ten patients had improvement or resolution of skin rash. In addition, we documented reduction of CXCL10 levels in the skin of seven subjects with GVHD after Calcipotriene course using non-invasive D-Squame® disc application to the skin for chemokine analysis. Our pilot study shows promising observation that topical Calcipotriene could be a novel therapeutic option for acute skin GVHD, especially in patients presenting with pruritus and should be studied in larger prospective studies.

Topics: Acute Disease; Calcitriol; Child; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Pilot Projects; Prospective Studies; Quality of Life

Topics: Acitretin; Acute Disease; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Body Surface Area; Calcitriol; Dermatologic Agents; Diagnosis, Differential; Drug Monitoring; Female; Humans; Immunosuppressive Agents; Keratolytic Agents; Middle Aged; Nurse Practitioners; Nursing Assessment; Patient Education as Topic; Phototherapy; Physical Examination; Primary Health Care; Psoriasis; Tacrolimus

1.25 (OH)2D3 is a potent inducer of differentiation of leukaemic cells into a monocytic direction. However, therapeutic application is difficult because of the development of hypercalcaemia. We examined a novel vitamin D analogue, MC 903, which is at least 100 times less effective on calcium metabolism in rats than 1.25 (OH)2D3. Using the HL-60 cell line, differentiation was measured with a comprehensive panel of qualitative and quantitative parameters. Development of monocytic cells was shown morphologically, immunophenotypically and functionally by increased capability of reducing NBT (vs cultures without MC 903, p less than 0.0001) and by qualitatively and quantitatively increased non-specific esterase activity. Furthermore, a concomitant decreased activity of myeloperoxidase and lactate dehydrogenase was noticed. In conclusion, MC 903 is a potent inducer of monocytic differentiation, comparable with 1.25 (OH)2D3 and will therefore be an interesting and potential therapeutic agent for studies in human acute leukaemia.

Topics: Acute Disease; Antigens, CD; Calcitriol; Carboxylic Ester Hydrolases; Cell Cycle; Cell Differentiation; Humans; Leukemia, Myeloid; Monocytes; Tumor Cells, Cultured

Topics: Acute Disease; Administration, Cutaneous; Aged; Calcitriol; Dermatitis, Contact; Female; Humans; Patch Tests; Psoriasis; Recurrence