A. Honigman1, R. De Cruz2, F. Lai1,2
In hematological malignancy and/or bone marrow failure, allogeneic haematopoietic stem cell transplantation (HSCT) can prove curative. It is however, associated with significant morbidity and mortality. Cutaneous complications of HSCT rate amongst the highest of any organ, resulting in prolonged hospital admissions. They include acute and chronic graft versus host disease (GVHD), cutaneous malignancy and infection.
Objectives: We studied the largest cohort of BMT recipients in Victoria over 6 years (2010–2015) to identify: (i) prevalence of cutaneous complications; (ii) impact of cutaneous disease on length of stay (LOS); (iii) frequency of dermatology referrals received. We aimed to highlight the need for a dedicated Dermatology service for BMT recipients.
Methods: A single-centre retrospective analysis conducted on all allogeneic HSCT patients over a 6-year-period from 2010–2015 (n = 236). Ethics approval was obtained from RMH’s Ethics Committee. BMT database and patient files reviewed to address clinical objectives.
Results: 94.1% of BMT patients experienced cutaneous complications during or after admission. The most common complications included chronic and acute GVHD, basal cell carcinoma, squamous cell carcinoma and varicella zoster reactivation. 32.4% of patients experienced acute GVHD whilst 87.3% experienced chronic cutaneous GVHD. Cutaneous malignancy affected 5.9% during the follow-up period. LOS was significantly impacted by cutaneous disease.
Conclusion: Acute and chronic cutaneous complications of allogeneic HSCT significantly impact upon the quality of life in BMT survivors. This analysis highlights the underrecognised cutaneous burden on BMT survivors. Whilst BMT Physicians are skilled at managing many HSCT complications, the hospital Dermatologist is critical in aiding diagnosis and directing therapy.