Prospects for ultraviolet A1 phototherapy as a treatment for chronic cutaneous graft-versus-host disease.
OBJECTIVE
Standard or investigative immunosuppressive therapies for cutaneous chronic graft-versus-host disease (GVHD) may prove not only ineffective but also cause serious adverse effects. Repeated exposure of the skin to ultraviolet radiation in the wavelength range 340-400 nm (so-called ultraviolet A1) was recently reported to have a strong local (intracutaneous) immunomodulatory activity. This study was undertaken to evaluate efficacy and safety of this phototherapy.


METHODS
Nine patients with cutaneous (4 lichenoid and 5 sclerodermoid) GVHD and mild or no other organ involvement were enrolled. All patients had developed serious drug toxicity and/or opportunistic infections. Phototherapy was administered three times a week.


RESULTS
Complete remission was seen in 5 (2 lichenoid and 3 sclerodermoid) cases and a partial improvement in 4 (2 lichenoid and 2 sclerodermoid) after having received 15.8+/-3.8 (lichenoid GVHD) or 21.6+/-8.0 (sclerodermoid GVHD) sessions of phototherapy. Adverse effects were not registered. At follow-up (range: 6-25 months), two patients with sclerodermoid lesions relapsed after 5 months but responded to another treatment cycle. Patients with lichenoid GVHD showed relapses within one month and prolonged maintenance phototherapy was needed. Problems of drug toxicity and opportunistic infections improved as phototherapy allowed the reduction or interruption of systemic drug therapies.


CONCLUSIONS
Ultraviolet A1 phototherapy may be considered as an appropriate therapeutic approach for sclerodermoid GVHD with no or mild involvement of internal organs. Patients with lichenoid GVHD should be treated only if they develop serious adverse effects to immunosuppressive therapies and opportunistic infections because of the carcinogenic hazard of high cumulative doses of ultraviolet A1 radiation.
Calzavara Pinton
Piergiacomo
P
Department of Dermatology, Spedali Civili, Brescia, Italy. calzavar@bshosp.osp.unibs.it
Porta
Fulvio
F
Izzi
Teodosio
T
Venturini
Marina
M
Capezzera
Rossana
R
Zane
Cristina
C
Notarangelo
Luigi Daniele
LD
D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007938:Leukemia / Q000601:surgery; D017512:Lichenoid Eruptions / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011701:PUVA Therapy / Q000379:methods*; D011446:Prospective Studies; D012594:Scleroderma, Localized / Q000209:etiology* / Q000628:therapy*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D007166:Immunosuppressive Agents