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Correspondence |

A Call for More Dermatologic Input Into Chronic Graft-vs-Host Disease Clinical Trials

Edward W. Cowen, MD, MHSc
Arch Dermatol. 2009;145(3):337-338. doi:10.1001/archdermatol.2008.606.
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I was very interested to read the case report by Moreno-Romero and colleagues1 in the “Cutting Edge” section of the September issue of the Archives. The authors describe clinical improvement in a patient with sclerodermatous chronic graft-vs-host disease (cGVHD) following treatment with low-dose (100 mg/d) imatinib mesylate (Gleevec in the United States, Glivec in other countries; Novartis International AG, Basel, Switzerland, manufacturer of both). Given the current lack of proven superiority of any single salvage therapy, this drug is generating considerable excitement in the transplantation community for its potential to treat the fibrosing manifestations of cGVHD. Other anecdotal reports2,3 and a small series4 have suggested that imatinib may indeed reduce the morbidity associated with 2 of the most treatment-refractory cGVHD manifestations, skin fibrosis and bronchiolitis obliterans. In an attempt to formally address this possibility, 2 prospective clinical trials of imatinib for cGVHD are currently under way at the National Institutes of Health Clinical Center and Stanford Cancer Center.

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Subcutaneous-type (A) and morpheaform-type (B) sclerotic chronic graft-vs-host disease (cGVHD). A, In the subcutaneous-type sclerotic cGVHD, extensive rippling and grooving of the skin is evident in a 41-year-old man 2 years after allogeneic stem-cell transplantation. Marked range-of-motion limitations are present at the elbow. Fasciitis was identified by magnetic resonance imaging. B, The morpheaform-type sclerotic cGVHD shows extensive dyspigmentation and localized firm sclerotic plaques on the central chest with surrounding patches of hyperpigmentation and hypopigmentation.

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