Bath PUVA therapy in pediatric patients with drug-resistant cutaneous graft-versus-host disease

Bonanomi, Sonia; Balduzzi, Adriana; Tagliabue, A; Biagi, Ettore; Rovelli, Attilio; Cortí, Paola; Crippa, D; Uderzo, C

doi:10.1038/sj.bmt.1703151

Cited by 11 publications

(5 citation statements)

References 9 publications

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“…Extracorporeal photopheresis has been successfully applied in chronic GVHD, particularly in cutaneous GVHD, and will need to be tested as first-line treatment of specific subgroups in steroid-refractory GVHD [92]. Furthermore, other light sources such as psoralen preparations and direct exposure to UVA have been proven to be effective in some patients with isolated cutaneous GVHD [93]. Standard treatment of chronic GVHD includes cyclosporine and prednisone.…”

Section: Basic Preventive and Therapeutic Approaches To (Cutaneous) Gvhdmentioning

confidence: 99%

Cutaneous Graft-versus-Host Disease: A Guide for the Dermatologist

et al. 2008

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Graft-versus-host disease (GVHD) is defined by the aggregation of clinical and pathological manifestations in a recipient of allogeneic stem cells or bone marrow transplantation in which specific immunological as well as nonspecific phenomena lead to characteristic features. GVHD is one of the major complications after hematopoietic stem cell transplantations and responsible for posttherapeutic morbidity, mortality and decrease in quality of life of those patients. GVHD is critically induced and maintained by donor immunocompetent cells that particularly attack epithelia of fast proliferating tissues such as those from the liver, gastrointestinal tract and skin. On the basis of the time of presentation, cutaneous GVHD has been originally divided into an acute and chronic disease. The latter has traditionally been further subclassified into a more epithelial or lichenoid and a predominantly dermal or sclerodermoid form. With respect to the growing importance of this therapeutic procedure and increasing numbers of outpatients presenting with chronic GVHD, this article summarizes the updated knowledge on this disease focused for the dermatologist, and additionally it emphasizes the recent consensus documents on the various aspects of chronic GVHD of the National Institute of Health.

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Section: Basic Preventive and Therapeutic Approaches To (Cutaneous) Gvhdmentioning

confidence: 99%

Cutaneous Graft-versus-Host Disease: A Guide for the Dermatologist

et al. 2008

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“…Jain et al [34] treated 20 patients with psoriasis (plaque psoriasis 18, guttate psoriasis 2) aged between 6 and 14 years with NBUVB. In a twice-weekly treatment regimen, the mean cumulative dose required for clearance was 4286 mJ/cm 2 (1,687-7,509 mJ/cm 2 ) over a mean number of treatment sessions of 24 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The highest dose per treatment was 329 mJ/cm 2 (165-462 mJ/cm 2 ).…”

Section: Puvamentioning

confidence: 99%

“…Mycosis fungoides (topical PUVA) [17] Lymphomatoid papulosis (bath PUVA) [18] Keratosis lichenoides chronica (bath PUVA) [19] Vitiligo (bath PUVA) [20] Urticaria pigmentosa/systemic mastocytosis [21] Generalized Schamberg's disease [22] Generalized granuloma annulare (bath PUVA) [23] Pansclerotic morphea (UVA) [24] Pansclerotic morphea [25,26] Cutaneous graft versus host disease (bath PUVA) [27] Palmoplantar keratoderma (bath PUVA) [28] Atopic dermatitis [29] BBUVB Psoriasis [16,30] Atopic dermatitis [16] Pityriasis lichenoides chronica [16] NBUVB Vitiligo [31,32] Psoriasis [33,34] Atopic dermatitis [33] Mycosis fungoides [35] Keratosis lichenoides chronica [36] Lichen nitidus [37] UVA1 (not discussed) Morphea, low-dose UVA1, combined with calcipotriol [38] Disabling pansclerotic morphea [39] Lichen sclerosus et atrophicus, low dose [40] Chronic graft versus host disease [41,42] Hypopigmented mycosis fungoides [43] been proven and, in comparison to BBUVB, it elicits faster clearance of lesions, fewer episodes of erythema and longer remission. However, large studies on phototherapy in childhood psoriasis are rare.…”

Section: Puvamentioning

confidence: 99%

Phototherapy and photochemotherapy in childhood dermatoses

Dogra

2010

Indian J Dermatol Venereol Leprol

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The concept of phototherapy and photochemotherapy is not new, and sophisticated ultraviolet (UV) treatment modalities are available for almost three decades. However, phototherapy has not been used in children as extensively as in adults, probably due to long-term safety concerns. Photochemotherapy (psoralen plus UVA) is not considered to be safe in the younger age group. UV therapies can be useful treatment options for children with selected dermatological conditions provided they are used under carefully controlled conditions. Presently there is insufficient data available to provide recommendations regarding the safe maximum dose and duration of phototherapy in children. Developments of new UV delivery systems and devices are aimed at improving the safety and efficacy of phototherapy. In this review, we discuss the published literature on phototherapy and photochemotherapy in children, drawbacks of their use in pediatric population and future prospects.

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“…Some studies included patients who were not relevant to the scope of our review, including acute GVHD patients and cGVHD patients without skin disease; these studies were labeled with an asterisk (*) in the included tables [13][14][15][16][17][18][19]. Whenever feasible, only cGVHD patients with cutaneous symptoms were counted toward the number of patients in each study with CR, PR, OI, and reduction in immunosuppression.…”

Section: Figure 2: Prisma Flow Diagrammentioning

confidence: 99%

“…Of the 76 patients across the eight PUVA studies examined, 26 (34.2%) experienced complete remission of their skin lesions, and another 30 (39.5%) experienced partial remission ( Table 2). Furthermore, several studies reported that patients achieved immunosuppression reduction post-therapy, demonstrating that managing cutaneous cGVHD is a crucial step in treating systemic disease [14][15][31][32][33][34][35].…”

Section: Psoralen In Combination With Uva (Puva)mentioning

confidence: 99%

Evidence-based, Skin-directed Treatments for Cutaneous Chronic Graft-versus-host Disease

Kim¹,

Lee²,

Kwong³

et al. 2019

Cureus

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Chronic graft-versus host disease (cGVHD) occurs in 30% to 70% of patients undergoing allogeneic hematopoietic cell transplantation (HCT). Cutaneous cGVHD affects 75% of cGVHD patients, causing discomfort, limiting the range of movement, and increasing the risk of wound infections. Furthermore, systemic immunosuppression is often needed to treat cGVHD and long-term use can lead to adverse events. Optimal use of skin-directed therapies is integral to the management of cutaneous cGVHD and may decrease the amount of systemic immunosuppression required. This study reviewed English-language articles published from 1990 to 2017 that evaluated the effect of skin-directed treatments for cutaneous cGVHD. A total of 201 papers were identified, 164 articles were screened, 46 were read, and 18 publications were utilized in the review. Skindirected treatments for cGVHD included topical steroids, topical calcineurin inhibitors, psoralen with ultraviolet A (PUVA) irradiation, ultraviolet A1 (UVA1) irradiation, and ultraviolet B (UVB) irradiation. We report the number of complete remissions, partial remissions, and systemic immunosuppression reduction in each study, as available. Twenty-two out of 30 (73.3%) patients experienced overall improvement with topical calcineurin inhibitors. At least 26 out of 76 patients (34.2%) receiving PUVA experienced complete remission, and 30 out of 76 patients (39.5%) experienced partial remission. In UVA1 studies, 44 out of 52 (84.6%) patients experienced overall improvement. In UVB studies, nine out of 14 patients (64.3%) experienced complete remission and four out of 14 patients (28.6%) experienced partial remission. As more HCTs are performed, more individuals will develop cGVHD. Awareness and optimal use of skin-directed therapies for cutaneous cGVHD may help improve patient outcomes and quality of life.

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Bath PUVA therapy in pediatric patients with drug-resistant cutaneous graft-versus-host disease

Cited by 11 publications

References 9 publications

Cutaneous Graft-versus-Host Disease: A Guide for the Dermatologist

Cutaneous Graft-versus-Host Disease: A Guide for the Dermatologist

Phototherapy and photochemotherapy in childhood dermatoses

Evidence-based, Skin-directed Treatments for Cutaneous Chronic Graft-versus-host Disease

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