Phototherapy for the treatment of cutaneous graft versus host disease

Abstract

Graft versus host disease (GvHD) occurs in half the patients who receive allogenic haematopoietic stem cell transplantation and is a major contributor for the morbidity and mortality in these patients. Immunosuppressant therapy cannot suppress all the manifestations of GvHD and new ways of treating the condition are needed. The focus of this review is the treatment of cutaneous GvHD through phototherapy. Of the six acute and ten chronic cutaneous GvHD case series examined the overall trend was that phototherapy was able to reduce the presence of cutaneous lesions of GvHD and, as a consequence, steroid use could be reduced. This provides a positive outlook for phototherapy as a treatment for cutaneous GvHD but there is a need for future studies to include larger numbers of patients in order to obtain more data.

Cutaneous Graft-Versus-Host Disease: Diagnosis and Treatment

“…When only the skin is involved, phototherapy modalities have been shown to be beneficial for steroid-refractory and steroid-dependent acute GVHD patients [ 103 – 106 ]. The immunomodulating effects of UV irradiation may allow for reduction of systemic immunosuppressive agents, consequently minimizing its side effects [ 103 – 106 ]. On the other hand, the increased risk for skin malignancies due to cyclosporin therapy, in addition to other immunosuppressive agents related to HSCT, should be considered.…”

Treatment rationale and design of a phase II study of narrow-band ultraviolet B phototherapy for cutaneous steroid-refractory acute graft-vs-host disease following allogenic stem-cell transplantation

“…With increases in the use of peripheral blood stem cells as a hematopoietic stem-cell source, HLA-mismatched and unrelated donors, and age of transplant recipients, GVHD will continue to be a serious challenge after allo-HSCT. Based on previous findings showing CR rates of 56% to 59% and ORR of 76% to 100%, [10–12,15,18] NB-UVB may be a viable therapeutic option for cutaneous aGVHD that otherwise may need systemic intensive immunosuppressive treatment. Moreover, because NB-UVB targets the skin, it is likely to enable sparing of corticosteroids or other systemic immunosuppressants for aGVHD, and thereby reduce the risks for adverse events caused by systemic immunosuppression.…”

Delayed presentation of toxic epidermal necrolysis-like cutaneous acute graft-versus-host disease in the setting of recent immunosuppressant discontinuation.

“…High potency topical corticosteroids can be used in isolation for patients with stage I cutaneous acute GvHD with no evidence of systemic involvement [10]. Lastly, phototherapy has been shown to be useful for clearing cutaneous GvHD, but further data is needed to fully characterize its use [11].…”