{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:03:41Z","timestamp":1756339421045,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>Treatment of recurrent acute lymphoblastic leukaemia (ALL) often involves allogeneic stem-cell transplantation (alloSCT) and disease recurrence in the central nervous system may require craniospinal irradiation. Although graft-versus-host disease (GVHD) is a known risk after alloSCT, cutaneous manifestation within radiation fields is rarely seen. The authors report a case of a 25-year-old man with Philadelphia+ALL recurring in the central nervous system after a homologous SCT. Craniospinal radiation was delivered with proton therapy to a total dose of 24 cobalt-Gray-equivalents in 12 fractions. Eight weeks after the proton therapy, significant cutaneous GVHD had developed within the radiation fields. This was treated successfully with tacrolimus (4 mg\/day), a short course of methylprednisolone, and topical treatment with 0.1% triamcinolone cream, 0.05% clobetasol ointment. Cutaneous GVHD after SCT can be seen within proton radiation fields probably due to an inherent higher skin dose.<\/jats:p>","DOI":"10.1136\/bcr.02.2012.5742","type":"journal-article","created":{"date-parts":[[2012,7,11]],"date-time":"2012-07-11T11:59:33Z","timestamp":1342007973000},"page":"bcr0220125742","source":"Crossref","is-referenced-by-count":2,"title":["Cutaneous graft-versus-host disease after proton-based craniospinal irradiation for recurrent Philadelphia-positive acute lymphoblastic leukaemia"],"prefix":"10.1136","volume":"2012","author":[{"given":"Hadley","family":"Sharp","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Grosshans","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tapan","family":"Kadia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bouthaina Shbib","family":"Dabaja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2012,7,11]]},"reference":[{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.1","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1182\/blood.V55.2.199.199","article-title":"Combination chemotherapy of adult acute lymphoblastic leukemia with randomized central nervous system prophylaxis.","volume":"55","author":"Omura","year":"1980","journal-title":"Blood"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19951215)76:12<2393::AID-CNCR2820761203>3.0.CO;2-P"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.3","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10265"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.4","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/12.1.197"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60237-3"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.6","doi-asserted-by":"publisher","DOI":"10.1097\/01.cco.0000357475.66035.d2"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.7","doi-asserted-by":"crossref","first-page":"4705","DOI":"10.1182\/blood.V90.12.4705","article-title":"Allogeneic peripheral blood stem cell transplantation may be associated with a high risk of chronic graft-versus-host disease.","volume":"90","author":"Storek","year":"1997","journal-title":"Blood"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.8","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-08-302109"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.coi.2005.07.017"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2004.03.003"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.11","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0560.2002.291001.x"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.12","doi-asserted-by":"publisher","DOI":"10.2307\/3574561"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.13","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(94)00421-G"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.14","first-page":"111","article-title":"Cutaneous chronic graft-versus-host disease localized to the field of total lymphoid irradiation.","volume":"17","author":"Okamoto","year":"1996","journal-title":"Bone Marrow Transplant"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.15","first-page":"133","article-title":"Unusual localization of cutaneous chronic graft-versus-host disease in the radiation fields in four cases.","volume":"4","author":"Socie","year":"1989","journal-title":"Bone Marrow Transplant"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(96)00540-8"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.17","doi-asserted-by":"publisher","DOI":"10.1177\/153303460300200506"},{"key":"2025082702225518000_2012.jul11_1.bcr0220125742.18","first-page":"43","article-title":"The relative biological effectiveness of the modulated proton beam at TRIUMF.","volume":"16","author":"Nemoto","year":"1998","journal-title":"Radiat Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr.02.2012.5742","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:23:03Z","timestamp":1756286583000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr.02.2012.5742"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,7,11]]},"references-count":18,"alternative-id":["10.1136\/bcr.02.2012.5742"],"URL":"https:\/\/doi.org\/10.1136\/bcr.02.2012.5742","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2012,7,11]]}}}