Although histopathological differences have been reported between acute graft-versus-host disease (aGVHD) rash and non-aGVHD rash in CD34+-selected peripheral blood stem cell transplantation (PBSCT) recipients, skin biopsy alone is usually insufficient to determine rash etiology. As such, distinguishing inflammatory non-aGVHD rashes, such as drug eruptions, from cutaneous aGVHD after CD34+-selected PBSCT remains challenging and relies on clinical presentation. This study aimed to identify etiologies of skin rash in the first year after CD34+-selected PBSCT and to assess whether laboratory serologic markers, transplant characteristics, and rash morphology and symptomatology aid in differentiation of cutaneous aGVHD rash versus non-aGVHD rash. We conducted a retrospective study of 243 adult patients who underwent CD34+-selected PBSCT at Memorial Sloan Kettering Cancer Center between 2008 and 2011. Among this cohort of transplant recipients, only 43 patients (17.7%) developed cutaneous aGVHD. A total of 152 patients (63%) were identified with rash within 1 year after PBSCT. The proportion of patients who experienced peripheral eosinophilia was not different between those with an aGVHD versus non-aGVHD rash (P ≥ .90), nor when stratified by CD34+ selection method (Isolex, P = .70; CliniMACS, P≥ .90). The proportion of patients with pruritus was also not different between those with an aGVHD rash versus non-aGVHD rash (P= .20), or when stratified by CD34+ selection modality (Isolex, P = .20; CliniMACS, P = .50). The most common cause of non-aGVHD rash among those with a clear etiology was drug (39% of Isolex; 26% of CliniMACS). Single drug culprits were identified in 51% of drug rashes. The most commonly reported offending agents included antibiotics, keratinocyte growth factor, chemotherapy, and recombinant glycosylated human IL-7.

中文翻译：

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药物是CD34 +选择的外周血干细胞移植后患者急性皮疹的常见原因。

尽管已报道在CD34 +选择的外周血干细胞移植（PBSCT）接受者中发生了急性移植物抗宿主病（aGVHD）皮疹和非aGVHD皮疹之间的组织病理学差异，但仅靠皮肤活检通常不足以确定皮疹的病因。因此，在CD34 +选择的PBSCT之后，将炎症性非aGVHD皮疹（例如药疹）与皮肤aGVHD区别开来仍然具有挑战性，并依赖于临床表现。这项研究旨在确定CD34 +选择的PBSCT后第一年的皮疹病因，并评估实验室血清学标志物，移植特征以及皮疹形态和症状是否有助于区分aGVHD皮疹和非aGVHD皮疹。我们对2008年至2011年间在纪念斯隆凯特琳癌症中心接受CD34 +选择的PBSCT的243名成年患者进行了回顾性研究。在该组移植受者中，只有43例患者（17.7％）发生了皮肤aGVHD。PBSCT术后1年内共鉴定出152例皮疹（63％）。有aGVHD皮疹和非aGVHD皮疹的患者发生外周嗜酸性粒细胞增多的比例没有差异（P≥.90），也没有通过CD34 +选择方法分层时发生的差异（Isolex，P = .70; CliniMACS，P≥.90） 。aGVHD皮疹与非aGVHD皮疹（P = .20）或按CD34 +选择方式分层时（Isolex，P = .20; CliniMACS，P = .50），瘙痒患者的比例也没有差异。 。在病因明确的患者中，非aGVHD皮疹的最常见原因是药物（Isolex的39％； CliniMACS的26％）。在51％的皮疹中发现了单一的毒品罪魁祸首。最常报告的令人讨厌的药物包括抗生素，角质形成细胞生长因子，化学疗法和重组糖基化的人IL-7。