title: Psoralen plus ultraviolet-A-bath photochemotherapy as an adjunct treatment modality in cutaneous chronic graft versus host disease.
abstract: BACKGROUND
  Cutaneous chronic graft versus host disease (GVHD) is a severe complication following allogeneic stem cell (PBSCT) and bone marrow transplantation (BMT). Immunosuppressive therapy consists of prednisone, cyclosporine-A, azathioprine or mycophenolate mofetil (MMF). Treatment of patients refractory to immunosuppression represents a major problem.
  
  
  METHODS
  We report six patients suffering from severe chronic GVHD of the skin who did not respond to immunosuppressive therapy or relapsed after reduction of glucocorticosteroids. Patients were treated with psoralen plus ultraviolet (PUVA)-bath photochemotherapy three times weekly following a standardized treatment protocol under continued treatment with prednisone and/or MMF. One patient was additionally pretreated with ultraviolet-A1 (UV-Al).
  
  
  RESULTS
  After a median of 14, 5 treatment sessions, skin lesions improved. Out of six patients, three showed a complete remission. In all patients, systemic immunosuppressive therapy could be reduced. In sclerodermic lesions, skin thickness returned to the levels of normal skin after 25 treatments confirmed by 20 MHz ultrasound evaluation. In a follow-up ranging from 2 to 21 months (median 10, 3 months), skin conditions remained stable.
  
  
  CONCLUSIONS
  Psoralen plus ultraviolet-A-bath represents an effective adjunct treatment option for extensive chronic and sclerodermic cutaneous GVHD offered by dermatologists. This is of high interest in patients suffering from cutaneous GVHD resistant to conventional immunosuppressive therapy and should be included to the menu of topical treatment options for chronic cutaneous GVHD.
authors.affiliation: Department of Dermatology, University of Ulm, Oberet Eselsberg 40, 89081 Ulm, Germany. ulrike.leiter@med.uni-tuebingen.de
authors.forename: Ulrike
authors.initials: U
authors.lastname: Leiter
authors.forename: Peter
authors.initials: P
authors.lastname: Kaskel
authors.forename: Gertraud
authors.initials: G
authors.lastname: Krähn
authors.forename: Petra
authors.initials: P
authors.lastname: Gottlöber
authors.forename: Donald
authors.initials: D
authors.lastname: Bunjes
authors.forename: Ralf-Uwe
authors.initials: RU
authors.lastname: Peter
authors.forename: Martina
authors.initials: M
authors.lastname: Kerscher
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011701:PUVA Therapy; D010789:Phototherapy; D011241:Prednisone / Q000008:administration & dosage; D012867:Skin / Q000473:pathology; D012871:Skin Diseases / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D033581:Stem Cell Transplantation / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D011241:Prednisone