Definition
Thiotepa is an alkylating agent that has been used clinically for several decades, often in combination with other chemotherapeutic drugs as a conditioning treatment prior to conventional stem cell transplantation (SCT) in haematological diseases or as a treatment option for solid tumours.rr Studies of high-dose thiotepa given (alone or in combination chemotherapy) to adult and paediatric patients have reported hyperpigmentation and erythema as the most common cutaneous toxicities, with exfoliation and desquamation reported less frequently. rr There is less information on the prevalence of skin toxicities in the adult population receiving thiotepa.
Pathophysiology
Thiotepa is partially excreted through the skin (as sweat); therefore, thiotepa-associated skin toxicity is thought to be caused by elevated local concentrations of thiotepa on the skin and may be more severe in the groin, axillae, skin folds, in the neck area and under dressings.rr
Incidence/prevalence
A consistent pattern of diffuse erythema with progression to desquamation and hyperpigmentation occurred in nearly 80% of 38 paediatric patients treated with a thiotepa-based chemotherapy regimen before autologous SCT.r
Onset/duration
On average, onset was 6.5 days after the first dose of thiotepa and progression from initial symptoms to diffuse involvement ranged from 2 to 4 days.r Superficial desquamation followed, and skin toxicities resolved after 18 days in approximately 50% of patients.r Hyperpigmentation was described as bronze-like or tan and often diffusely affected the skin at onset but became patchy and irregular as it faded over several weeks to months.r