Psoralen plus ultraviolet-A-bath photochemotherapy as an adjunct treatment modality in cutaneous chronic graft versus host disease.
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.
Leiter
Ulrike
U
Department of Dermatology, University of Ulm, Oberet Eselsberg 40, 89081 Ulm, Germany. ulrike.leiter@med.uni-tuebingen.de
Kaskel
Peter
P
Krähn
Gertraud
G
Gottlöber
Petra
P
Bunjes
Donald
D
Peter
Ralf-Uwe
RU
Kerscher
Martina
M
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
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D011241:Prednisone