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Blood, 18 June 2009, Vol. 113, No. 25, pp. 6338-6341.
Prepublished online as a Blood First Edition Paper on April 23, 2009; DOI 10.1182/blood-2009-03-210989.


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Submitted March 18, 2009
Accepted April 10, 2009

Pralatrexate-induced tumor cell apoptosis in the epidermis of a patient with HTLV-1 adult T-cell lymphoma/leukemia (ATLL) causing skin erosions

Alexander G. Marneros*, Marc E. Grossman, David N. Silvers, Sameera Husain, Gerard J. Nuovo, Barbara MacGregor-Cortelli, Ellen Neylon, Molly Patterson, Owen A. O'Connor, and Jasmine M. Zain

Department of Dermatology, Columbia Presbyterian Medical Center, New York, NY, United States
Comprehensive Cancer Center, Ohio State University Medical Center, Columbus, OH, United States
Department of Medicine, Columbia Presbyterian Medical Center, New York, NY, United States
Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States

* Corresponding author; email: alexander_marneros{at}yahoo.com.

Pralatrexate is a novel antifolate, which shows increased anti-tumor activity in human tumor xenograft studies in mice as compared to methotrexate. We investigated the effects of pralatrexate in a patient with adult T-cell lymphoma/leukemia (ATLL) with significant skin involvement. Atypical lymphocytes in epidermal Pautrier microabscesses were positive for HTLV-1. After the patient presented with leukemic conversion and with worsening of an erythematous generalized papular rash, he received one dose of pralatrexate. Within one week his skin developed innumerable small erosions limited to the areas of the papular rash, sparing unaffected skin. Here we present in vivo evidence that pralatrexate-induced erosions in skin affected by ATLL are a manifestation of apoptosis of tumor cells infiltrating the epidermis and are not due to cytotoxicity by pralatrexate on keratinocytes. This distinction is critical and may profoundly influence the clinical decision to continue pralatrexate treatment. Pralatrexate-induced skin erosions may indicate response to treatment.


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Related Article in Blood Online:

Cutaneous tumor lysis syndrome in a patient with HTLV-1 adult T-cell lymphoma/leukemia
Jean-David Bouaziz, Nadège Cordel, Geoffroy Hickman, Claire Fieschi, Nicolas Ortonne, and Martine Bagot
Blood 2009 114: 4320-4321. [Full Text] [PDF]



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J.-D. Bouaziz, N. Cordel, G. Hickman, C. Fieschi, N. Ortonne, and M. Bagot
Cutaneous tumor lysis syndrome in a patient with HTLV-1 adult T-cell lymphoma/leukemia
Blood, November 5, 2009; 114(19): 4320 - 4321.
[Full Text] [PDF]



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