Skin issues post BMT

[ecb220]

My mom had a 10/10 sibling match BMT in January, and by all measures has been doing really well. Her counts are all up and stable-ish (platelets at 100k), energy has been improving, and spirits have been restored. Truly amazing and a miracle after 3+ years of medical issues.

She is (I think) completely off the tacrolimus & sirolimus, and is down to 7.5mg prednisone (aka the "damn steroids" as she likes to call them). She's had mild but steady gastro issues and some skin rash, but no real flair ups of GVHD beyond that.

A week and a half ago she bumped into a curtain rod that was on the ground, and got three cuts on her shins. One in particular is really bad, and her doctor had a skin graft doctor consult with her this weekend. He recommended she get a skin graft on at least two of the cuts, and said of the bad one that the skin is dead and it will not heal if she does nothing. Her transplant doctor is concerned/curious that this is indicative of an underlying issue with GVHD or a reaction to the steroids, and wants to do a skin biopsy first.

So that's where we are right now - wait and see essentially. My mom strongly does not want to get a skin graft - surgery, pain, hospitalization, etc. - but it's unclear if she'll have a choice.

Does anyone have experience with skin graft or other skin issues post BMT that demonstrate like this? Reaction to meds, GVHD, another issue? Any information is appreciated, thanks.

[Neil Cuadra]

How unfortunate that your mom got cut this way.

This article says that anti-inflammatory corticosteroids (like prednisone) can inhibit the proper healing of wounds. Perhaps being offs meds (or further reducing the prednisone, if possible) could help your mom regain some of her natural healing ability, but I'd be very surprised if that kind of change would happen instantly.

With only a rash, it seems that she hadn't had serious GVHD skin issues, but the biopsy may reveal more information about it.

You might ask the dermatologist or plastic surgeon if they think this type of result from a serious cut (a non-healing wound, dead skin, and the need for a skin graft) is common or uncommon given the type of cut. If they say it's common then your mom may simply be the victim of an accident that could have happened to anyone. But if they consider this unusual then it's definitely important to let the hematologist do a full study.

In either case, you should hear from all of these doctors before deciding whether a skin graft is the only (or best) choice.