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January 2001

The "Drug vs Graft-vs-Host Disease" ConundrumGets Tougher, but There Is an Answer: The Challenge to Dermatologists

Arch Dermatol. 2001;137(1):75-76. doi:10.1001/archderm.137.1.75

ANY DERMATOLOGIST who has beenconsulted to see a patient who has had a bone marrow transplant (BMT)and then developed a new rash recognizes the difficulty indistinguishing a drug eruption from graft-vs host-disease(GVHD). Over the coming years this is going to be a more, notless, frequent source of frustration for several reasons. Bone marrowtransplantation has grown by over 10-fold between 1985 and 1995, and itcontinues to grow by 10% to 20% annually to more than 15 000procedures per year worldwide.1 This is not surprisingbecause BMT is the only hope for survival for many patients withhematologic malignant neoplasms, and improving technology and survivalrates have extended the clinical indications considerably. A distincttrend though is that owing to new technologies for suppressing acuteGVHD and a lack of perfectly matched donors, more BMT recipients arereceiving less closely matched transplants. In combination, thesefactors mean continued rapid growth in the number of potentiallylifesaving transplantations but also ever-higher numbers of patientswho will develop acute GVHD or chronic GVHD, with the most commonlyaffected site being skin.2