Topical ruxolitinib is promising as sole or adjunctive therapy in treating maculopapular rash of acute and chronic skin GVHD

Abstract

Skin is commonly involved in acute and chronic graft versus host disease (GVHD). Ruxolitinib 1.5% cream is a topical Janus Kinase (JAK)1/2 inhibitor approved for atopic dermatitis and vitiligo but has not been evaluated for treatment of skin GVHD. We conducted a retrospective review of patients with acute or chronic skin GVHD who received topical ruxolitinib. Responses and adverse effects were reviewed. Ten patients, median age 11.5 years (range 0.9-37 years) with acute(n=7) or chronic(n=3) skin GVHD were treated with topical ruxolitinib. Topical ruxolitinib was applied to >20% BSA in all acute GVHD patients and 1 chronic GVHD patient. In 5 evaluable acute skin GVHD patients, 2 had a complete response, 2 had a partial response, and one patient did not respond to topical ruxolitinib. In 2 evaluable chronic GVHD patients, the maculopapular erythematous rash resolved in 1 patient and improved in 1 patient. No infections or allergic reactions to ruxolitinib cream was observed, despite exceeding 20% BSA application.Ruxolitinib topical cream is a promising treatment for acute skin GVHD and non-sclerotic chronic skin GVHD rash.