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Abstract
Systemic autoimmune diseases are reportedly associated with a high frequency of drug allergies. In particular, systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and adult-onset Still's disease (AOSD) have recently drawn attention. Based on previous reports, drug allergies have been reported in 17.1-63%, 7-40.1%, and 17.6-54% of patients with SS, SLE, and AOSD patients, respectively. Antimicrobial agents, including sulfa drugs and nonsteroidal anti-inflammatory drugs, are the most common causative agents of drug allergies. However, few studies have examined in detail the relationship between drug eruptions, a major symptom of drug allergy, and systemic autoimmune diseases, and their actual status remains unclear. These autoimmune diseases commonly exhibit a diverse range of skin manifestations in the course of these diseases, rendering it may be difficult to determine whether it is a true drug eruption. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), a fatal, severe drug eruption, has also been associated with autoimmune diseases. The development of SS-like symptoms after SJS/TEN onset and high prevalence of anti-SS-A antibodies in SJS/TEN are intriguing observations. Although the presence of SLE is known to be a risk factor for SJS/TEN, common pathological conditions, such as excessive immune status, abnormal function of regulatory T cells, and neutrophil extracellular traps in autoimmune diseases such as SS and SLE, are potentially involved in the development of drug eruptions.
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Affiliation(s)
- Yuko Watanabe
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Yukie Yamaguchi
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Allegra A, Di Salvo E, Casciaro M, Musolino C, Pioggia G, Gangemi S. The Impact of Immunological Checkpoint Inhibitors and Targeted Therapy on Chronic Pruritus in Cancer Patients. Biomedicines 2020; 9:biomedicines9010002. [PMID: 33375183 PMCID: PMC7822170 DOI: 10.3390/biomedicines9010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 02/08/2023] Open
Abstract
Although pruritus may sometimes be a consequential situation to neoplasms, it more frequently emerges after commencing chemotherapy. In this review, we present our analysis of the chemotherapy treatments that most often induce skin changes and itching. After discussing conventional chemotherapies capable of inducing pruritus, we present our evaluation of new drugs such as immunological checkpoint inhibitors (ICIs), tyrosine kinase inhibitors, and monoclonal antibodies. Although ICIs and targeted therapy are thought to damage tumor cells, these therapies can modify homeostatic events of the epidermis and dermis, causing the occurrence of cutaneous toxicities in treated subjects. In the face of greater efficacy, greater skin toxicity has been reported for most of these drugs. A remarkable aspect of some reports is the presence of a probable correlation between cutaneous toxicity and treatment effectiveness in tumor patients who were treated with novel drugs such as nivolumab or pembrolizumab. Findings from these experiments demonstrate that the occurrence of any grade of skin side effects can be considered as a predictor of a better outcome. In the near future, studies on the relationship between the onset of skin alterations and outcomes could open new perspectives on the treatment of neoplasms through specific target therapy.
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Affiliation(s)
- Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98125 Messina, Italy;
- Correspondence: ; Tel.: +39-090-221-2364
| | - Eleonora Di Salvo
- Department of Veterinary Sciences, University of Messina, 98125 Messina, Italy;
| | - Marco Casciaro
- School of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (M.C.); (S.G.)
- Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Caterina Musolino
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98125 Messina, Italy;
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy;
| | - Sebastiano Gangemi
- School of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (M.C.); (S.G.)
- Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
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Yau P, Jimenez-Zepeda VH, Bailey K, Duggan P, Tay J, Bahlis NJ, Neri P, McCulloch S. Slow lenalidomide desensitization protocol for patients with multiple myeloma: case series from a single center. Leuk Lymphoma 2019; 60:3199-3203. [DOI: 10.1080/10428194.2019.1627537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Patrick Yau
- Department of Pharmacy, Tom Baker Cancer Center, Calgary, AB, Canada
| | | | - Kyla Bailey
- Department of Pharmacy, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Peter Duggan
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Jason Tay
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Nizar J. Bahlis
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Paola Neri
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Sylvia McCulloch
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
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Boudin L, Patient M, Roméo E, Bladé JS, de Jauréguiberry JP. Induction de tolérance après toxidermie au lénalidomide au cours d’un syndrome 5q-. Bull Cancer 2017; 104:814-816. [DOI: 10.1016/j.bulcan.2017.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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Barley K, He W, Agarwal S, Jagannath S, Chari A. Outcomes and management of lenalidomide-associated rash in patients with multiple myeloma. Leuk Lymphoma 2016; 57:2510-5. [DOI: 10.3109/10428194.2016.1151507] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Seki JT, Sakurai N, Kukreti V. Lenalidomide Desensitization in Systemic Light-Chain Amyloidosis With Multi-Organ Involvement. J Clin Med Res 2015; 7:807-11. [PMID: 26346623 PMCID: PMC4554222 DOI: 10.14740/jocmr2303e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 01/19/2023] Open
Abstract
Limited therapeutic options are available to amyloid patients treated with many lines of therapy. Although combination therapy using lenalidomide and dexamethasone is an effective sequential regimen for systemic amyloidosis (AL), dexamethasone is often poorly tolerated in patients with cardiac involvement. Lenalidomide as single agent has modest activity, but when used in combination with dexamethasone, careful titration is needed. Dermatological adverse reactions can be problematic to patients on lenalidomide-based therapy. Lowering lenalidomide doses have not been able to consistently prevent recurrent skin toxicity. We report a patient who was neither eligible for stem cell transplant nor able to tolerate previous lines of therapy. Therapeutic dilemma arose from lenalidomide-related moderately severe skin toxicity. We enrolled the patient in the lenalidomide rapid desensitization program (RDP) with success in the presence of poor cardiac reserve and renal impairment. No recurrence of skin rash was observed during the course of therapy. To the best of our knowledge, this was the first AL patients who received and tolerated RDP well, despite multi-organ impairments. The target dose may be achieved based on individual patient’s ability to tolerate RDP. Incremental dose increase can be applied in future dates without risk of rash recurrence.
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Affiliation(s)
- Jack T Seki
- Department of Pharmacy, Princess Margaret Hospital, Toronto, ON, Canada ; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada ; College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, USA
| | - Naoko Sakurai
- Department of Pharmacy, Princess Margaret Hospital, Toronto, ON, Canada
| | - Vishal Kukreti
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Imbesi S, Allegra A, Calapai G, Musolino C, Gangemi S. Cutaneous adverse reactions to lenalidomide. Allergol Immunopathol (Madr) 2015; 43:88-91. [PMID: 24998775 DOI: 10.1016/j.aller.2013.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/26/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
Abstract
Lenalidomide is an immunomodulatory drug (IMiD) used principally in the treatment of multiple myeloma (MM), myelodysplastic syndromes (MS) and amyloidosis. Adverse reactions related to lenalidomide include myelosuppression (mainly neutropenia but also thrombocytopenia), gastrointestinal problems, skin eruption, atrial fibrillation and asthenia, decreased peripheral blood stem cell yield during stem cell collection, venous thromboembolism, and secondary malignances. In this review we focused our attention on the cutaneous adverse reactions to lenalidomide.
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Lee MJ, Wickner P, Fanning L, Schlossman R, Richardson P, Laubach J, Castells M. Lenalidomide desensitization for delayed hypersensitivity reactions in 5 patients with multiple myeloma. Br J Haematol 2014; 167:127-31. [DOI: 10.1111/bjh.12925] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Min Jung Lee
- Division of Rheumatology, Immunology and Allergy; Department of Medicine; Brigham and Women's Hospital; Boston MA USA
| | - Paige Wickner
- Division of Rheumatology, Immunology and Allergy; Department of Medicine; Brigham and Women's Hospital; Boston MA USA
| | - Laura Fanning
- Division of Rheumatology, Immunology and Allergy; Department of Medicine; Brigham and Women's Hospital; Boston MA USA
| | | | - Paul Richardson
- Jerome Lipper Multiple Myeloma Center; Dana-Farber Cancer Institute; Boston MA USA
| | | | - Maria Castells
- Division of Rheumatology, Immunology and Allergy; Department of Medicine; Brigham and Women's Hospital; Boston MA USA
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Musolino C, Alonci A, Catena S, Rizzotti P, Russo S, Rotondo F, Allegra A. Long-term complete remission in a multiple myeloma patient after Stevens-Johnson syndrome due to lenalidomide therapy. Acta Oncol 2013; 52:1050-1. [PMID: 23113590 DOI: 10.3109/0284186x.2012.732706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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