Severe Adverse Skin Reaction Used For Sclerodermatous Chronic Graft Versus Host Disease Of The Skin
Bibliographic record
Abstract
Abstract Treatment of sclerodermatous chronic graft versus host disease remains a daunting challenge. Supportive care measures remain the primary mode of therapy with little evidence of treatments that reverse the process. Photopheresis has been used with varying success in this disorder. Recently, case reports and case series have reported on the successful use of imatinib in this disorder(1, 2) Drug intolerance was reported in four of the patients treated. We report a case of a 40 year old man with extensive scelerodermatous chronic graft versus host disease (GVHD) of the skin ( Skin : score of 3 using the NIH Criteria). Four years earlier, he underwent a matched unrelated stem cell transplant for chronic myelogenous leukemia. His transplant course was complicated with TTP associated with all standard immune suppressive agents (cyclosporine, tacrolimus, sirolimus). This gentleman developed progressive sclerodermatous skin GVHD. Photopheresis was carried out for two years with stabilization, but no improvement in his symptoms. Imatinib was started due to persistent symptoms (joint restriction Score of 2 in NIH criteria, > 50% of skin involvement, joint Ð score of 3 NIH). 3 Imatinib was started for progressive symptoms and within five days, he was hospitalized with a generalized erythroderma with associated skin sloughing. The Imatinib was stopped and he received high dose steroids with slow improvement of his symptoms. Skin biopsy at that time revealed subcorneal pustular dermatosis; there was no herpes viral effects and special stains were negative for bacterial or fungal organisms. There was a diffuse infiltration of neutrophils. Histological differential diagnosis included pustular psoariasis and Sneedon-Wilkinson syndrome. In view of the history, the concluding diagnosis was exanthematous pustulosis secondary to imatinib. We recommend that close attention be paid to patients with chronic GVHD treated with imatinib and early intervention with stopping the Imatinib. Steroid worked in this case and should be considered.Blood 2009 Mar. Magro et alArch Dermatol 2008 Sept; 144(9): 1106-9 National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. Diagnosis and Staging Working Group Repor Alexandra H. Filipovich,1 Daniel Weisdorf,2 Steven Pavletic, et al Biology of Blood and Marrow Transplantation 11:945-955 (2005). Disclosures: No relevant conflicts of interest to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".