Correspondence

Cutaneous Reactions to STI571

N Engl J Med 2001; 345:618-619August 23, 2001

Article

To the Editor:

The remarkable effects of the tyrosine kinase inhibitor STI571 in chronic myeloid leukemia and acute lymphoblastic leukemia reported by Druker et al. (April 5 issue)1,2 are frequently associated with adverse cutaneous reactions. The rash was described in only two patients — as “exfoliative dermatitis” in one and as a “persistent and progressive rash” in the other.1,2 We recently observed a severe adverse cutaneous reaction in a patient with chronic myeloid leukemia who was treated with STI571; it was an acute generalized exanthematous pustulosis, a well-characterized cutaneous reaction to drugs.3,4 Interestingly, the scarlatiniform erythema with nonfollicular pustules was confined to flexural areas; such a pattern is often seen in skin reactions to mercury.3 Mercury interferes with some tyrosine kinases.3 As shown in Table 1Table 1Incidence of Adverse Cutaneous Reactions According to the Daily Dose of STI571., which was compiled from published reports,1-3,5 the incidence of cutaneous reactions to STI571 appears to be dose-dependent. This might indicate that they are related to the pharmacologic effect of the drug rather than to hypersensitivity.

Michel Brouard, M.D., Ph.D.
Jean-Hilaire Saurat, M.D.
University Hospital, CH-1211 Geneva, Switzerland
mcvpb@hotmail.com

5 References

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   Druker BJ, Talpaz M, Resta DJ, et al. Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia. N Engl J Med 2001;344:1031-1037
   Full Text | Web of Science | Medline

2. 2

   Druker BJ, Sawyers CL, Kantarjian H, et al. Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. N Engl J Med 2001;344:1038-1042
   Full Text | Web of Science | Medline

3. 3

   Brouard M, Prins C, Mach-Pascual S, Saurat JH. Acute generalized exanthematous pustulosis associated with STI571 in a patient with chronic myeloid leukemia. Dermatology (in press).
   

4. 4

   Roujeau JC, Bioulac-Sage P, Bourseau C, et al. Acute generalized exanthematous pustulosis: analysis of 63 cases. Arch Dermatol 1991;127:1333-1338
   CrossRef | Web of Science | Medline

5. 5

   Joensuu H, Roberts PJ, Sarlomo-Rikala M, et al. Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med 2001;344:1052-1056
   Full Text | Web of Science | Medline

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