布伦妥昔单抗维多汀相关皮疹的组织病理学和临床特征描述

IF 4.5 1区 医学 Q1 PATHOLOGY
American Journal of Surgical Pathology Pub Date : 2024-09-01 Epub Date: 2024-06-20 DOI:10.1097/PAS.0000000000002268
Saisindhu Narala, Atif Saleem, Ryanne A Brown, Roberto A Novoa, Youn H Kim, Kerri E Rieger
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引用次数: 0

摘要

布伦妥昔单抗维多汀(BV)是一种用于治疗皮肤T细胞淋巴瘤(CTCL)的CD30靶向抗体药物共轭物,皮疹是布伦妥昔单抗维多汀常见的不良反应之一。然而,BV相关皮疹(BVAR)的临床和组织病理学特征描述非常有限。将 BVAR 与患者潜在的 CTCL 区分开来具有挑战性,可能导致治疗中断甚至过早停药。我们对一家机构的 BVAR 进行了全面的临床和组织病理学回顾性鉴定。利用聚合酶链反应(PCR)和T细胞受体高通量测序(TCR-HTS),我们从临床上提示为BVAR的皮疹中分离出了皮肤活检标本,这些标本也缺乏优势TCR克隆。我们对 14 名患者的 26 份活检标本进行了回顾性评估。BVAR的临床特征包括:主要为病态或斑丘疹形态、发病延迟、中度至重度分级趋势,通常需要口服类固醇。大多数组织病理标本(25/26)显示海绵状皮炎为主要反应模式。许多病例有细微的发现,支持背景界面或苔癣样糜烂。四分之一的标本可见朗格汉斯细胞微脓肿,超过二分之一的标本存在嗜酸性粒细胞。病灶特征与 CTCL 相似,但并不突出。在 17 份免疫组化标本中,表皮内淋巴细胞的 CD4:CD8 比率相对正常(1-6:1)的占 65%(11/17),1:1 的占 35%(6/17),与基线 CTCL 相比,CD8 阳性细胞有增加的趋势。我们发现了有助于将 BVAR 与患者的 CTCL 区分开来的特征,这反过来又有助于指导适当的临床治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Histopathologic and Clinical Characterization of Brentuximab Vedotin-associated Rash.

Rash is one of the commonly observed adverse events with brentuximab vedotin (BV), a CD30-targeted antibody-drug conjugate used to treat cutaneous T-cell lymphoma (CTCL). However, clinical and histopathologic characterization of BV-associated rash (BVAR) is limited. Distinguishing BVAR from a patient's underlying CTCL can be challenging and can lead to treatment interruptions or even premature drug discontinuation. We performed a thorough clinical and histopathologic retrospective characterization of BVAR from a single institution. Utilizing polymerase chain reaction (PCR) and T-cell receptor high-throughput sequencing (TCR-HTS), we were able to isolate skin biopsy specimens from rash clinically suggestive of BVAR that also lacked a dominant TCR clone. A retrospective evaluation was performed of 26 biopsy specimens from 14 patients. Clinical features of BVAR included predominantly morbilliform or maculopapular morphology, delayed onset, and the trend toward moderate to severe classification, often requiring oral steroids. Most histopathologic specimens (25/26) showed spongiotic dermatitis as the primary reaction pattern. Many cases showed subtle findings to support a background interface or lichenoid eruption. Langerhans cell microabscesses were seen in one-fourth of specimens, and eosinophils were present in over one-half of the specimens. There were focal features mimicking CTCL, but these were not prominent. In 17 specimens with immunohistochemistry, the CD4:CD8 ratio in intraepidermal lymphocytes was relatively normal (1-6:1) in 65% (11/17) and 1:1 in 35% (6/17), demonstrating a trend toward increased CD8-positive cells compared with baseline CTCL. We have identified features that can help distinguish BVAR from a patient's CTCL, which can, in turn, help guide appropriate clinical management.

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来源期刊
CiteScore
10.30
自引率
5.40%
发文量
295
审稿时长
1 months
期刊介绍: The American Journal of Surgical Pathology has achieved worldwide recognition for its outstanding coverage of the state of the art in human surgical pathology. In each monthly issue, experts present original articles, review articles, detailed case reports, and special features, enhanced by superb illustrations. Coverage encompasses technical methods, diagnostic aids, and frozen-section diagnosis, in addition to detailed pathologic studies of a wide range of disease entities. Official Journal of The Arthur Purdy Stout Society of Surgical Pathologists and The Gastrointestinal Pathology Society.
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