UVA (UVA-1) therapy for the treatment of acute GVHD of the skin

Schlaak, Max; Schwind, Sabine; Wetzig, Tino; Maschke, Jan; Treudler, Regina; Basara, N; Lange, T.; Simon, Jan C.; Niederwieser, D; Al-Ali, Haifa Kathrin

doi:10.1038/bmt.2010.230

Cited by 31 publications

(33 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In 11 of our patients, we were able to avoid the use of systemic corticosteroids in mild-moderate GvHD similar to the study by Schlaak et al, in which systemic steroids could be avoided in 67% of patients with the use of UVA1 as primary therapy. 10 We also found that in patients with severe skin GvHD, use of phototherapy may help in rapid tapering of systemic steroids similar to Feldstein et al study. 7 We cannot distinguish the effects of steroids and phototherapy when they are given together.…”

supporting

confidence: 54%

Efficacy of narrow band UVB in the treatment of cutaneous GvHD: an Indian experience

George

Peter

Chopra

et al. 2016

Bone Marrow Transplant

View full text Add to dashboard Cite

Acute GvHD occurs in 450% of patients 1 and mainly affects the skin, gastrointestinal (GI) tract and liver. If skin is the predominant or the only organ involved, skin-directed therapy such as phototherapy is an option. Phototherapy has been used mainly as an adjuvant treatment in steroid-refractory or steroiddependent GvHD, with responses varying from 50 to 100%. 2,3 Psoralen with UVA (PUVA) has been shown to be efficacious in both acute and chronic GvHD; 4-6 however, the theoretical risk of skin cancer and potential hepatic toxicity has prompted the use of narrow band UVB (NBUVB) in cutaneous GvHD with proven efficacy in a few series of acute GvHD and overlap syndromes recently in adults and children. 7,8 In this retrospective study, we analyzed the efficacy of NBUVB as a treatment option in acute cutaneous GVHD.Twenty patients who received NBUVB phototherapy for the treatment of acute GvHD following stem cell transplantation (SCT) with predominant skin manifestations between May 2010 and June 2013 were studied after approval by the institutional review board. During this period, 420 patients underwent SCT of which 153 (36.4%) developed acute GvHD and 120 (28.5%) had skin GvHD. The diagnosis of acute GvHD was based on clinical criteria supported by biopsy (n = 18) and on clinical criteria alone (n = 2) after excluding other etiologies such as viral exanthems and drug rashes. Transient rashes lasting o 72 h were excluded. Clinical staging was done according to the Glucksberg criteria. 9Patients received phototherapy as primary treatment along with topical steroids or topical tacrolimus when GvHD involved the skin predominantly (stage 2-3) and extracutaneous manifestations were relatively stable. It was given with oral steroids in the presence of stage 2-3 skin GvHD and significant GI or liver GvHD. It was also given for the appearance of skin GvHD following tapering of systemic steroids or other immunosuppressants (Table 1). Patients with stage 4 skin GvHD or who were unwell were not considered for treatment with NBUVB. NBUVB was administered in a full body upright UV therapy cabinet (Daavlin 3 series 311/350, Bryan, OH, USA) fitted with 24 flourescent bulbs emitting light with a 311-nm wavelength. All patients being of skin type IV or V, NBUVB was set at the lowest dose initially, the initial dose being 60 mJ/cm 2 and then gradually increased by 20-30 mJ/cm 2 , and was given on alternate days either twice or thrice weekly. It was discontinued if the patient was clinically clear of rash or developed significant GvHD in other organ systems or if patient was unable to come for the phototherapy sessions. A complete remission (CR) was defined as complete clearance of lesions with no evidence of cutaneous GvHD at the end of the treatment. Partial remission was defined as reduction of lesions, either a reduction in the erythema or in duration of lesions, or in percentage of body surface area involved by the end of treatment, and no response when there was no reduction with phototherapy or there was worsening of skin ...

show abstract

supporting

confidence: 54%

Efficacy of narrow band UVB in the treatment of cutaneous GvHD: an Indian experience

George

Peter

Chopra

et al. 2016

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…This study reported the length of time between the first administration of phototherapy until neoplastic change as 180 days (melanoma) to 1590 days (squamous cell carcinoma). 31 In the other study, the follow-up period was shorter (between 150 and 270 days), which may account for neoplastic changes being seen only in the study that examined a large sample size over a long period of time. Both studies concluded that systemic steroid administration could be reduced after the use of phototherapy.…”

Section: Acute Gvhdmentioning

confidence: 94%

“…In one study patients receiving the antifungal agent voriconazole were treated with UVA doses of up to 40 J/cm 2 with no side-effects. 31 However another study reported the development of skin neoplasias after UVA treatment, and these included one case of melanoma, one of basal cell carcinoma and one of squamous cell carcinoma. This study reported the length of time between the first administration of phototherapy until neoplastic change as 180 days (melanoma) to 1590 days (squamous cell carcinoma).…”

Section: Acute Gvhdmentioning

confidence: 98%

See 1 more Smart Citation

Phototherapy for the treatment of cutaneous graft versus host disease

Garbutcheon‐Singh

Fernández‐Peñas

2014

Aust J Dermatology

View full text Add to dashboard Cite

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.

show abstract

“…steroidabhängiger aGvHDPatienten eine wichtige Therapieoption dar, wobei die Anwendung von UVA-1 und Schmalband-UVB im Gegensatz zur PUVA (Psoralen plus Ultraviolett A)-Therapie aufgrund des geringeren Risikos für maligne Hautveränderungen bevorzugt werden sollte [33].…”

Section: Second-line-therapieunclassified