Non-melanoma skin cancer outcomes in kidney transplant recipients converted from calcineurin inhibitors to mTOR inhibitors: a systematic review

Renal transplant recipients treated with calcineurin inhibitors (CNIs) are at a high risk of developing a skin cancer. Therefore, new therapeutic options such as inhibitors of the mammalian target of rapamycin (mTORi) have been studied to find treatment regimens decreasing the rate of skin cancers. This systematic review focuses on recent randomized controlled trials studying the impact of conversion from CNI to mTORi in renal transplant recipients on development of non-melanoma skin cancers (NMSC). Outcomes of analysed trials revealed that conversion from CNI to mTORi in post-transplant patients reduces the risk and delays the occurrence of NMSC. However, mTORi protective properties against NMSC are more effective in patients with a history of a single SCC compared with multiple SCCs. At the same time, conversion to mTORi is associated with more common discontinuations secondary to adverse events and also increased mortality. In conclusion, conversion to mTORi is protective against NMSC but given the high AE rates and therapy discontinuation there is a need to determine who would benefit from conversion and search for new treatment regimens including combination strategies with mTORi

Table_1_Rare COVID-19 vaccine side effects got lost in the shuffle. Primary cutaneous lymphomas following COVID-19 vaccination: a systematic review.DOCX

IntroductionCOVID-19 vaccines are generally safe and effective; however, they are associated with various vaccine-induced cutaneous side effects. Several reported cases of primary cutaneous lymphomas (CLs) following the COVID-19 vaccination have raised concerns about a possible association. This systematic review aims to investigate and elucidate the potential link between CLs and SARS-CoV-2 vaccines.MethodsWe performed a systematic literature search on PubMed, EBSCO and Scopus from January 01, 2019, to March 01, 2023, and analyzed studies based on determined eligibility criteria. The systematic review was performed based on the PRISMA protocol.ResultsA total of 12 articles (encompassing 24 patients) were included in this analysis. The majority of CLs were indolent cutaneous T-cell lymphomas (CTCLs) (66,7%; 16/24), with Lymphomatoid papulosis (LyP) being the most common type (33,3%; 8/24). Most patients (79,2%; 19/24) developed lesions after receiving the COVID-19 mRNA-based vaccines, and predominantly after the first immunization dose (54,2%; 13/24). The presented CLs cases exhibited a tendency to exacerbate following subsequent COVID-19 vaccinations. Nevertheless, CLs were characterized by a favorable course, leading to remission in most cases.ConclusionThe available literature suggests an association between the occurrence and exacerbation of CLs with immune stimulation following COVID-19 vaccination. We hypothesize that post-vaccine CLs result from an interplay between cytokines and disrupted signaling pathways triggered by vaccine components, concurrently playing a pivotal role in the pathomechanism of CLs. However, establishing a definitive causal relationship between these events is currently challenging, primarily due to the relatively low rate of reported post-vaccine CLs. Nonetheless, these cases should not be disregarded, and patients with a history of lymphoproliferative disorders require post-COVID-19 vaccination monitoring to control the disease’s course.Systematic review registrationwww.researchregistry.com, identifier [1723].</p

Superficial and deep cutaneous fungal infections in solid organ transplant recipients

Due to the fact that the number of solid organ transplant recipients is increasing, the population of immunosuppressed individuals is growing. Immunosuppression predisposes organ transplant recipients to the development of fungal infections that cause not only graft failure but also mortality. Immunosuppression makes diagnosis difficult due to atypical signs and symptoms of mycoses. Treatment of infections may be complicated because of fungal resistance to commonly used drugs, drug interactions and the requirement to continue immunosuppression to avoid graft rejection. This article provides a review of superficial and invasive fungal infections within the skin, including diagnostic and therapeutic methods. Quick identification of the pathogen and appropriate treatment are essential to the life of patients

The role of polymorphism of interleukin 2, 10, 13 and TNF-α genes in cutaneous T-cell lymphoma pathogenesis

Introduction : As the pathogenesis of cutaneous T-cell lymphomas (CTCL) is not fully understood, inherited gene polymorphisms are considered to play a role in the development of lymphomas. Aim : To investigate whether certain gene polymorphisms might be involved in the development of CTCL. Material and methods: In the case-control study we compared the frequency of nine selected single nucleotide polymorphisms (SNP) of seven genes ( rs1800587/–889 C/T of interleukin (IL)-1α, rs2069762/–330G/T ) and rs2069763/+166G/T of IL-2, rs1800925/–1112 C/T of IL-13, rs1800896/–1082 A/G of IL-10, rs4073/–251 A/T of IL-8, rs5370/K198N, rs180054/–1370T/G of endothelin-1 and rs1800629/–308 G/A of TNF-α) in 43 CTCL and Polish cases using the amplification refractory mutation system polymerase chain reaction method. Results : We have found that two genotypes, –330GG of IL-2 and – 1112TT of IL-13 both promoter variants associated with “hypertranscription phenotype”, were over-represented in CTCL patients compared to healthy controls, and they increase the risk of malignancy development (OR = 5.82, p = 0.001 for IL-2 –330 GG, and OR = 5.67, p = 0.0024 for IL-13 –1112 TT). On the other hand, high transcription –308A allele of the TNF-α gene and –1082GG of IL-10 genotype is less frequent in lymphoma patients and has protective effects on the development of CTCL (OR = 0.45, p = 0.0466 for –308A of TNF-α, and OR = 0.35, p = 0.0329 for –1082GG of IL-10 genes). Conclusions : Our results indicate that hypertranscription promoter variants of IL-2 and IL-13 genes could be estimated as the risk factor for development of CTCL, while TNF-α and IL-10 variants have a protective effect

Primary cutaneous lymphomas. Diagnostic and therapeutic guidelines of the Polish Dermatological Society (PTD) and Polish Lymphoma Research Group (PLRG)

Primary cutaneous lymphomas are a heterogeneous group of rare lymphoproliferative diseases that are initially limited to the skin but potentially also involve the lymph nodes, blood, and occasionally visceral organs. They develop from mature T cells, B cells, and NK cells. The classification includes a wide range of pathologies, each characterized by distinct clinical symptoms and variations in disease course. Cutaneous lymphomas are typically chronic in nature, and a complete cure is rarely achievable. Since primary cutaneous lymphomas are uncommon and present in many variants, they pose diagnostic and therapeutic challenges that require multidisciplinary collaboration between dermatologists, pathologists, hematologists, and oncologists. We present revised guidelines for the diagnosis and treatment of primary cutaneous lymphomas, with the goal of simplifying the diagnostic and therapeutic procedure in routine clinical practice. The guidelines cover the clinical, histopathological, and dermoscopic characteristics of skin lesions, along with recommendations for the diagnostic and therapeutic management of primary cutaneous lymphomas. When selecting the most suitable therapeutic approach for individual patients diagnosed with primary cutaneous lymphoma, the main factor to consider should be the clinical stage of the disease. However, other factors, such as the patient’s age, overall health, and medical history, should also be taken into account. The choice of therapy should be guided by finding optimal efficacy and safety. The guidelines also include globally recognized therapeutic approaches that are currently not accessible in Poland. The recommendations rely on the existing Polish and global guidelines, and the knowledge and experience of experts