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Master Thesis

La maladie aiguë du greffon contre l’hôte (GVHa) de type Lyell : description d’une cohorte de patients et comparaison historique, clinique, biologique et pharmacologique

Abstract : “Lyell’s-like” acute graft-versus-host disease (GVHa) is difficult to distinguish from Lyell’s syndrome. From the data analysis extracted from a cohort, the purpose of this study was to identify parameters to distinguish these two entities. From 2004 to 2014, we conducted a monocentric retrospective study of 14 cases of GVHa-Lyell which was compared to the one of 9 patients, published by Villada et al. A maculopapular rash preceded the appearance of bullae and 64% involved palmoplantar area. The average cutaneous detachment occurred 29 days after allograft. In 64% of cases there was a digestive GVHa and in 50% cases hepatic GVHa. Histology was unable to distinguish these two entities. According to the ALDEN score, a possibility of drug involvement was present in 8 cases and probable in 5 cases. Average SCORTEN was 3.6. Mortality =100 days and overall mortality were 57% and 85% respectively. Patients with probable involvement of drugs had better overall survival when the drug was stopped early. Patients described by Villada et al showed a cutaneous detachment 38 days after allograft (p = NS). Mortality in =100 days and overall mortality were 88% and 100% accordingly (p = NS). To distinguish “Lyell’s-like” GVHa from Lyell’s syndrome remains difficult. SCORTEN average is not adapted to this population because it underestimates mortality. A morbilliform eruption prior to cutaneous detachement and the palmoplantar area involvement did not help to consolidate the diagnosis of GVHa rather than the Lyell’s syndrome. Extra-cutaneous GVHa are parameters to be considered while stopping attributable drugs.
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https://dumas.ccsd.cnrs.fr/dumas-01205566
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Submitted on : Friday, September 25, 2015 - 4:42:15 PM
Last modification on : Monday, October 19, 2020 - 11:06:31 AM
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  • HAL Id : dumas-01205566, version 1

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Jean-Benoît Monfort. La maladie aiguë du greffon contre l’hôte (GVHa) de type Lyell : description d’une cohorte de patients et comparaison historique, clinique, biologique et pharmacologique. Médecine humaine et pathologie. 2015. ⟨dumas-01205566⟩

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