melphalan and Skin-Diseases

Topics: Acne Vulgaris; Adult; Aged; Child, Preschool; Female; Gonorrhea; Hirsutism; Humans; Ichthyosis; Infant; Male; Melphalan; Middle Aged; Psoriasis; Sarcoidosis; Skin Diseases; Skin Neoplasms; Syphilis; Tetracycline; United States

Bortezomib (Btz) shows robust efficacy in patients with multiple myeloma (MM); however, some patients experience suboptimal responses and show specific toxicities. Therefore, we attempted to identify specific HLA alleles associated with Btz-related toxicities and response to treatment. Eighty-two transplant-ineligible patients with newly diagnosed MM enrolled in a phase II study (JCOG1105) comparing two less intensive melphalan, prednisolone, plus Btz (MPB) regimens were subjected to HLA typing. The frequency of each allele was compared between the groups, categorized based on toxicity grades and responses to MPB therapy. Among 82 patients, the numbers of patients with severe peripheral neuropathy (PN; grade 2 or higher), skin disorders (SD; grade 2 or higher), and pneumonitis were 16 (19.5%), 15 (18.3%), and 6 (7.3%), respectively. Complete response was achieved in 10 (12.2%) patients. Although no significant HLA allele was identified by multiple comparisons, several candidates were identified. HLA-B*40:06 was more prevalent in patients with severe PN than in those with less severe PN (odds ratio [OR] = 6.76). HLA-B*40:06 and HLA-DRB1*12:01 were more prevalent in patients with SD than in those with less severe SD (OR = 7.47 and OR = 5.55, respectively). HLA-DRB1*08:02 clustered in the group of patients with pneumonitis (OR = 11.34). Complete response was achieved in patients carrying HLA-DQB1*03:02, HLA-DQB1*05:01, and HLA-DRB1*01:01 class II alleles. HLA genotyping could help predict Btz-induced toxicity and treatment efficacy in patients with MM, although this needs further validation.

Topics: Aged; Antineoplastic Agents; Bortezomib; Female; Gene Frequency; Genotyping Techniques; HLA Antigens; Humans; Japan; Male; Melphalan; Multiple Myeloma; Peripheral Nervous System Diseases; Pneumonia; Prednisolone; Skin Diseases; Treatment Outcome

One hundred and seventy-five children with Stage 3 or 4 neuroblastoma who had obtained a good response to conventional therapy were randomly allocated to 13-Cis retinoic acid at a dose of 0.75 mg/kg/day or placebo for up to 4 years. Toxicity was mild but no advantage in event-free survival was shown for the children receiving retinoic acid.

Topics: Adolescent; Adult; Antineoplastic Agents, Alkylating; Cheilitis; Child; Child, Preschool; Dose-Response Relationship, Drug; Double-Blind Method; Follow-Up Studies; Humans; Infant; Isotretinoin; Melphalan; Neoplasm Staging; Neoplasm, Residual; Neuroblastoma; Skin Diseases; Survival Analysis; Survival Rate; Treatment Outcome

Hematopoietic stem cell allograft is a treatment for patients with severe constitutional or acquired hematopoietic system diseases. This act is always linked to complications requiring multidisciplinary care. Our study describes the post-allograft cutaneous complications.. A prospective study was conducted at the Hematology department of "20 Août Hospital" in Casablanca during a period going from January 2018 to December 2020; including all patients who presented acute or chronic cutaneous complications post-allograft.. Twenty-five patients were included. All patients received induction chemotherapy (Busulfan/Fludarabine or Busulfan/Melphalan). A skin infection was found in 8 patients : four cases of Malassezia folliculitis, one case of perineal zona, one case of genital herpes, one case of varicella and one case of Candida sepsis. The acute graft versus host reaction was found in 3 patients, revealed by an erythematous rash all over the body. The chronic graft versus host reaction was found in five patients on a lichenoid form. Nine patients had a hyperpigmentation of the folds followed by detachment in the same areas, concluding to a Busulfan toxidermy.. Hematopoietic stem cell allograft has many complications. The literature mainly specifies hematological and digestive complications, while skin complications are little described. Our series is special by reporting different types and mechanisms of skin complications that can occur; with a predominance of skin graft-on-host reactions and infections. It also reports an unusual Busulfan toxidermy.

Topics: Acute Disease; Adolescent; Adult; Allografts; Busulfan; Candidiasis; Chickenpox; Child; Chronic Disease; Dermatomycoses; Female; Graft vs Host Disease; Hematologic Diseases; Hematopoietic Stem Cell Transplantation; Herpes Genitalis; Humans; Induction Chemotherapy; Malassezia; Male; Melphalan; Middle Aged; Morocco; Prospective Studies; Skin Diseases; Skin Diseases, Infectious; Vidarabine; Young Adult

Forty patients (median age, 31 years; range, 20 to 63) with Hodgkin lymphoma underwent an allogeneic stem cell transplant with the gemcitabine-fludarabine-melphalan reduced-intensity conditioning regimen. Thirty-one patients (77%) had undergone a prior autologous stem cell transplant, with a median time to progression after transplant of 6 months (range, 1 to 68). Disease status at transplant was complete remission/complete remission, undetermined (n = 23; 57%), partial remission (n = 14; 35%), and other (n = 3; 8%). Twenty-six patients (65%) received brentuximab vedotin before allotransplant. The overall complete response rate before allotransplant was 65% in brentuximab-treated patients versus 42% in brentuximab-naive patients (P = .15). At the latest follow-up (October 2015) 31 patients were alive. The median follow-up was 41 months (range, 5 to 87). Transplant-related mortality rate at 3 years was 17%. Pulmonary, skin toxicities, and nausea were seen in 13 (33%), 11 (28%), and 37 (93%) patients, respectively. At 3 years, estimates for overall and progression-free survival were 75% (95% CI, 57% to 86%) and 54% (95% CI, 36% to 70%). Overall incidence for disease progression was 28% (95% CI, 16% to 50%). We believe the gemcitabine-fludarabine-melphalan regimen allows moderate dose intensification with acceptable morbidity and mortality. The inclusion of gemcitabine affected nausea, pulmonary, and likely skin toxicity. Exposure to brentuximab vedotin allowed more patients to reach allogeneic stem cell transplantation in complete remission. With over 50% of patients progression-free at 3 years, allogeneic stem cell transplantation with reduced-intensity conditioning remains an effective and relevant treatment option for Hodgkin lymphoma in the brentuximab vedotin era.

Topics: Adult; Brentuximab Vedotin; Deoxycytidine; Female; Gemcitabine; Hematopoietic Stem Cell Transplantation; Hodgkin Disease; Humans; Immunoconjugates; Lung Diseases; Male; Melphalan; Middle Aged; Nausea; Remission Induction; Salvage Therapy; Skin Diseases; Survival Analysis; Transplantation Conditioning; Transplantation, Homologous; Vidarabine; Young Adult

A 56-year-old married female presented in May 1998 with a 5-month history of xanthelasma of the eyelids, followed 4 months later by two enlarged lymph nodes of the left side of the neck and three of the left axilla. At the same time, she developed xanthomatous patches on the face, neck, and shoulders (Fig. 1). The cutaneous lesions were xanthomatous nodules and plaques, affecting the periorbital regions. Later, the whole face was affected, followed by ulcerated lesions on the scalp, chest, back, and extremities (Fig. 2). The skin lesions became painful, pruritic, ulcerated tumors (Fig. 3). In July 1998, computed tomography (CT) scans of the chest and abdomen with contrast medium showed pretracheal, bilateral axillary, right retrochural, paracaval, aortocaval, and para-aortic lymph node enlargement. These findings were suggestive of lymphoma. CT scan also showed slight heterogeneous hypodensity in the upper part of the right lobe of the liver, suggesting fatty infiltration. The spleen, pancreas, and suprarenal glands appeared normal. One cervical and two left axillary lymph nodes were excised. They revealed total replacement of the nodular architecture by a diffuse proliferation of mature lymphoid cells having small nuclei and a crumbled chromatin pattern, and very rare mitosis. It was concluded from the lymph node biopsies that these changes were typical of non-Hodgkin's lymphoma, diffuse and small cell type, of low-grade malignancy. A bone marrow aspirate showed a marrow heavily infiltrated by lymphoid cells with some immaturity. The megakaryopoiesis was adequate. Trephine biopsies showed similar changes. Iron stores appeared to be absent. The bone marrow picture was consistent with diffuse, well-differentiated non-Hodgkin's lymphoma, developing into chronic lymphocytic leukemia (CLL). Endoscopy showed antral-type gastric mucosa exhibiting mild chronic gastritis. Skin biopsy from a fresh lesion on the back showed a diffuse inflammatory cell infiltrate with collections of histiocytic cells. It also showed necrobiotic foci, surrounded by mixed inflammatory cells, dark palisaded foamy histiocytes, and a few Touton giant cells. These findings are compatible with necrobiotic xanthogranuloma (NXG) (Figs 4 and 5). Blood film showed normochromic, normocytic erythrocytes with anisopoikilocytotic leukocytes and normal platelets. The sedimentation rate was 90 mm in the first hour. The blood picture also showed monoclonal IgG paraprotein (3170 mg/dL) of the kappa li

Topics: Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; Chlorambucil; Cyclophosphamide; Female; Glucocorticoids; Granuloma; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, Non-Hodgkin; Melphalan; Middle Aged; Necrobiotic Disorders; Paraproteinemias; Skin Diseases; Treatment Failure; Treatment Outcome; Xanthomatosis

Here we report an unusual case of primary systemic amyloidosis. The cutaneous lesions were polymorphic and included involvement of both external auditory canals. The visceral involvement was covert. Mapping of amyloid deposits was performed using scintigraphy with technetium-99m (V) dimercaptosuccinic acid ([99mTc (V)] DMSA). Therapy with melphalan, prednisone and colchicine resulted in considerable improvement.

Topics: Aged; Amyloidosis; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Colchicine; Female; Gout Suppressants; Humans; Melphalan; Prednisone; Radionuclide Imaging; Skin Diseases; Technetium Tc 99m Dimercaptosuccinic Acid

Plasmacytosis, a distinctive proliferative disorder of plasma cells, is characterized by peculiar multiple skin eruptions, lymphadenopathy and polyclonal hypergammaglobulinemia. To date there has been no report of such cases showing remarkable responses to therapeutic agents. We herein report a case of plasmacytosis which developed in a 52-year-old Korean man and showed remarkable improvement with melphalan.

Topics: Humans; Male; Melphalan; Middle Aged; Plasma Cells; Skin; Skin Diseases

A 43-year-old man suffered from migrating then additive arthralgias associated with macroscopic and microscopic cutaneous lesions compatible at first sight with reticular erythematous mucinosis. After nine months, the cutaneous picture evolved into a papular mucinosis. The patient developed "multiple frozen joints" with heterotopic bony deposits around the hips. To our knowledge, such articular problems have not yet been described in this condition. Severe systemic complications prompted the authors to treat the patient with plasma exchange and melphalan.

Topics: Adult; Anti-Inflammatory Agents; Bone and Bones; Choristoma; Hip; Humans; Hydroxychloroquine; Joint Diseases; Male; Melphalan; Mucins; Plasma Exchange; Prednisolone; Skin Diseases

Scleromyxedema is an uncommon fibromucinous connective tissue disease characterized by accumulation of mucinous material in the dermis. A monoclonal paraprotein is regularly identified. A review of the literature (57 cases) shows the exceptional association of scleromyxedema with multiple myeloma (8.7%) and macroglobulinemia Waldenström (3.5%). A man with scleromyxedema, IgG lambda paraproteinemia, and sclerodactylia--as a special sign of scleromyxedema--is reported. Melphalan is the drug of choice in serious cases, but not effective in sclerodactylia.

Topics: Fingers; Humans; Hypergammaglobulinemia; Immunoglobulin G; Male; Melphalan; Microscopy, Electron; Middle Aged; Multiple Myeloma; Paraproteinemias; Scleroderma, Localized; Skin; Skin Diseases; Syndrome; Waldenstrom Macroglobulinemia

Scleromyxedema (generalized lichen myxedematosus) is a rare variant of papular mucinosis characterized clinically by generalized waxy papules and marked cutaneous induration. Histologically, there is fibromucinous infiltration of the superficial dermis. Most patients also have had a monoclonal serum protein of cathodal mobility. The case to be presented is remarkable for the following reasons: 1. the presence of esophageal aperistalsis; 2. the presence of prominent dermal eosinophilia; and 3. the absence of a serum monoclonal paraprotein.

Topics: Adult; Deglutition Disorders; Eosinophilia; Humans; Male; Melphalan; Paraproteins; Skin Diseases

We report two cases of scleromyxedema treated with melphalan (alkeran) and dermabrasion, both patients with central nervous system involvement. In the first case, herpetic encephalitis, possibly due to the immunoglobulin disturbance, preceded the skin changes. In the second case, impaired cerebral function was caused by a meningeoma. In the first case of short duration it seems as if progression of the disease has been arrested. In the second, of more than 26 years duration the skin changes have seemed unchanged, sclerotic for some years, though some improvement was noticed following dermabrasion.

Topics: Adult; Aged; Dermabrasion; Female; Humans; Melphalan; Myxedema; Skin Diseases

Scleromyxedema is an uncommon cutaneous fibromucinous disease with a monoclonal protein, which has resisted a number of therapies. Eight cases followed up for as long as 12 years have provided an opportunity to observe the effects of melphalan treatment in this disease. The fibrohistiocytic and mucinous change of the skin in scleromyxedema and often the monoclonal protein can be controlled by low-dose chemotherapy. Although melphalan does not usually produce clinical toxic effects of importance, it is a myelotoxic drug and cytopenia is common; one patient died of acute myelomonocytic leukemia after ten years of successful therapy of the scleromyxedema, thus implying that long-term therapy may be dangerous by itself. These patients require close supervision. Leukocyte and platelet counts must be performed every three weeks, and the dosage of melphalan adjusted accordingly.

Topics: Adult; Blood Proteins; Female; Humans; Male; Melphalan; Middle Aged; Plasma Cells; Skin Diseases

Topics: Female; Humans; Leukemia, Erythroblastic, Acute; Melphalan; Middle Aged; Myxedema; Skin Diseases

The conditions of three patients who had generalized granuloma annulare responded favorably to treatment with alkylating agents. This mode of therapy in two cases was chosen on the basis of recent evidence that implicates delayed hypersensitivity mechanisms as forming part of the pathogenesis of granuloma annulare. Two patients had rapid clearing of their lesions. The response in one of these patients was observed during therapy for a concomitant plasma cell dyscrasia. The third patient had an unusual form of granuloma annulare that had evolved during a period of 28 years, with hand deformities secondary to fascial and tendon involvement and the production of contractures and lymphedema, which responded partially to therapy. The results lend further support to data implicating cellular immunity to granuloma annulare.

Topics: Aged; Alkylating Agents; Chlorambucil; Female; Granuloma; Humans; Male; Melphalan; Middle Aged; Prednisone; Skin Diseases

Topics: Adult; Humans; Male; Melphalan; Paraproteinemias; Skin Diseases; Syndrome

Topics: Amyloidosis; Drug Therapy, Combination; Humans; Immunoglobulin D; Immunoglobulin Light Chains; Male; Melphalan; Multiple Myeloma; Nails; Prednisone; Remission, Spontaneous; Sebaceous Glands; Skin Diseases

Topics: Aged; Female; Humans; Melanins; Melphalan; Nails; Pigmentation Disorders; Skin Diseases

An unusual, nodulocystic form of scleromyxedema (lichen myxedematosus) developed in a 48-year-old man with a six-year history of psoriasis. The scleromyxedema responded to intermittent therapy with melphalan and prednisone. Dermabrasion smoothed and softened the skin and increased the mobility of the perioral skin. Two months after remission of the skin lesions, psoriasis recurred.

Topics: Dermabrasion; Humans; Male; Melphalan; Middle Aged; Mucopolysaccharidoses; Myxedema; Paraproteinemias; Prednisone; Psoriasis; Recurrence; Skin Diseases

Topics: Adult; Blood Protein Disorders; Blood Protein Electrophoresis; Bone Marrow; Bone Marrow Cells; Brain Edema; Bronchopneumonia; Chondroitin; Culture Techniques; Fluorescent Antibody Technique; Glycoproteins; Humans; Hyaluronic Acid; Immunoelectrophoresis; Immunoglobulin G; Male; Melphalan; Myxedema; Skin; Skin Diseases; Sulfuric Acids

Topics: Antineoplastic Agents; Azathioprine; Chlorambucil; Cyclophosphamide; Hair; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Melphalan; Mercaptopurine; Methotrexate; Neoplasms; Scleroderma, Systemic; Skin Diseases; Vinblastine

Topics: Adult; Aged; Blood Protein Disorders; Diagnosis, Differential; Female; Humans; Immunoglobulin G; Immunoglobulins; Immunosuppressive Agents; Male; Melphalan; Methotrexate; Middle Aged; Multiple Myeloma; Myxedema; Scleroderma, Systemic; Serum Globulins; Skin Diseases

Topics: Blood Protein Disorders; gamma-Globulins; Humans; Male; Melphalan; Middle Aged; Sclerosis; Skin Diseases

Topics: Aged; Biopsy; Female; gamma-Globulins; Humans; Immunoelectrophoresis; Melphalan; Myxedema; Skin; Skin Diseases