Narrowband ultraviolet B phototherapy in the treatment of cutaneous graft-versus-host disease in oncohaematological paediatric patients

Brazzelli, Valeria; Grasso, Vincenzo; Muzio, F.; Moggio, Erica; Zecca, Marco; Locatelli, Franco; Borroni, G.

doi:10.1111/j.1365-2133.2009.09503.x

Cited by 44 publications

(34 citation statements)

References 38 publications

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“…20 Possible targets of UVR are Langerhans cells, which may be depleted or altered, affecting their capacity to present antigens, 21 and keratinocytes, which release immunosuppressive cytokines. 19,[22][23][24]20,25 PUVA bath photochemotherapy, 26 ultraviolet B light, 27 narrowband UVB (NB-UVB), 28 and ultraviolet A-1 (UVA-1) 29 phototherapies have all shown efficacy in small series or case reports. Although epidermal (and particularly the lichen planuselike GVHD phenotypes) may respond to UVB and NB-UVB, deep sclerotic changes do not.…”

Section: Wound Managementmentioning

confidence: 99%

Graft-versus-host disease

Hymes

Alousi

Cowen

2012

Journal of the American Academy of Dermatology

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Section: Wound Managementmentioning

confidence: 99%

Graft-versus-host disease

Hymes

Alousi

Cowen

2012

Journal of the American Academy of Dermatology

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“…Die chronische GvHD (cGvHD) manifestierte sich nach historischer Einteilung ab dem Tag 100 nach SCT. Diese strenge Zeitgrenze muss angesichts von Fortschritten in der Kenntnis der Klinik und Pathophysiologie der GvHD als willkürlich und damit obsolet angesehen werden [3]. In den letzten Jahren konnte sich eine neue Klassifikation der GvHD durchsetzen, die sich an klinischen und pathologischen Kriterien orientiert [13].…”

Section: Graft-versus-host-diseaseunclassified

Graft-versus-Host-Disease (GvHD) – ein Update

et al. 2011

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GvHD remains associated with significant morbidity and mortality despite new techniques for allogeneic stem cell transplantation (SCT), such as optimized conditioning regimens. Within the past ten years, the incidence of acute GvHD has remained unchanged and the incidence of chronic GvHD has even increased. The traditional classification of GvHD according to the time of clinical manifestation is now out-dated. Acute GvHD symptoms may even occur after 100 days; vice versa, primary chronic GvHD may already be observed one month after stem cell transplantation. The current classification introduced by the National Institutes of Health includes classic acute GvHD (up to 100 days), late-onset acute GvHD (after 100 days), as well as an overlap syndrome showing features of acute and chronic GvHD and classic chronic GvHD without any time limit. Diagnosis of GvHD of the skin remains difficult because of histological similarities to drug eruptions and viral exanthems. In this first part of the article the pathophysiology, classification, skin manifestations of acute and chronic GvHD and the histopathology will be presented. In a second part the prognosis, prophylaxis and therapy of GvHD will be discussed.

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“…In all, 10 pediatric patients treated with narrowband UVB alongside systemic immunosuppression showed promising results, with 80% of patients achieving CR of their GVHD after a median of 7.5 weeks of treatment. 35 UVB is less carcinogenic than PUVA, and narrowband UVB less erythrogenic.…”

mentioning

confidence: 97%

More than skin deep? Emerging therapies for chronic cutaneous GVHD

Rodgers

Burge

Scarisbrick

et al. 2012

Bone Marrow Transplant

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The options for treating skin disease after haemopoietic progenitor cell transplant (HPCT) have broadened considerably over the last decade to include much more than topical steroids and emollients. This article reviews current and emerging therapies for chronic cutaneous GVHD, a well-recognised complication of HPCT. Alongside skin-directed therapies, there is now a wide range of systemic agents with differing targets for which an evidence base is emerging. Of particular interest, we summarise the role of electrocorporeal photopheresis, a therapy increasingly used in the United Kingdom to treat severe sclerodermoid manifestations of GVHD. We include a discussion of the expanding knowledge of the pathogenesis of cutaneous GVHD, which is informing our understanding and development of second line therapies (for example, the role of B cells and the utility of rituximab). Additionally, we draw attention to challenges encountered in the evaluation of chronic GVHD treatments and highlight recommendations for further research that may enable haematologists and dermatologists to provide better care for these patients. Finally, we present a clinical algorithm to aid the approach to treating limited and extensive disease and steroid refractory or persistent disease where steroid sparing may be necessary.

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Narrowband ultraviolet B phototherapy in the treatment of cutaneous graft-versus-host disease in oncohaematological paediatric patients

Abstract: This study provides evidence that NB-UVB phototherapy represents a valid second-line treatment in paediatric patients affected by GVHD and refractory to immunosuppressive first-line treatment.

Cited by 44 publications

References 38 publications

Graft-versus-host disease

Graft-versus-host disease

Graft-versus-Host-Disease (GvHD) – ein Update

More than skin deep? Emerging therapies for chronic cutaneous GVHD

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