title: Narrowband ultraviolet B phototherapy for the treatment of steroid-refractory and steroid-dependent acute graft-versus-host disease of the skin.
abstract: BACKGROUND
  Acute graft-versus-host disease (aGvHD) is a common complication of allogeneic stem cell transplantation. It is usually treated with high doses of corticosteroids and other immunosuppressive agents. When cutaneous features are predominant, narrowband ultraviolet B (NB-UVB) phototherapy may be an attractive option for its steroid-sparing effect.
  
  
  OBJECTIVE
  We sought to examine the clinical efficacy of NB-UVB in the treatment of steroid-refractory and steroid-dependent cutaneous aGvHD.
  
  
  METHODS
  We conducted a retrospective chart review of patients with steroid-refractory and steroid-dependent aGvHD, who received NB-UVB between 2005 and 2009 at our institution.
  
  
  RESULTS
  We identified 14 patients with aGvHD treated with NB-UVB between 2005 and 2009. The median number of treatments was 15, administered over a median of 43 days. Eight of 14 patients (57%) achieved a complete response at the end of treatment; an additional 3 patients (21%) achieved a partial response; and 3 patients (21%) showed no improvement at the time when phototherapy was discontinued (nonresponders). Four patients developed chronic graft-versus-host disease (GvHD). Three of the 8 complete responders remained free of GvHD at 6 months' follow-up.
  
  
  CONCLUSIONS
  The rarity of steroid-refractory aGvHD limited the study to a small number of participants. Because GvHD is variable in its presentation and course, and life-threatening in many cases, large controlled prospective trials for potential therapies are difficult.
  
  
  CONCLUSIONS
  NB-UVB is a viable option for the treatment of steroid-refractory and steroid-dependent aGvHD of the skin.
authors: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Jonathan V
authors: JV
authors: Feldstein
authors: Sidney Kimmel Comprehensive Cancer Center, Division of Hematologic Malignancies, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Javier
authors: J
authors: Bolaños-Meade
authors: Sidney Kimmel Comprehensive Cancer Center, Division of Hematologic Malignancies, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Viki L
authors: VL
authors: Anders
authors: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: r.abuav@gmail.com.
authors: Rachel
authors: R
authors: Abuav
references: N Engl J Med. 1979 Apr 12;300(15):809-13
references: 423919
references: N Engl J Med. 1997 Apr 10;336(15):1041-5
references: 9091799
references: Bone Marrow Transplant. 2008 Jun;41 Suppl 2:S65-70
references: 18545247
references: Transplantation. 2002 Dec 15;74(11):1631-4
references: 12490799
references: N Engl J Med. 1999 Jul 1;341(1):14-21
references: 10387937
references: J Am Acad Dermatol. 1985 Jan;12(1 Pt 1):30-7
references: 3980801
references: Br J Dermatol. 2008 Sep;159(4):931-5
references: 18834483
references: Dermatology. 2008;216(4):287-304
references: 18230976
references: Bone Marrow Transplant. 1999 Jan;23(2):151-5
references: 10197800
references: Blood. 2003 Jul 15;102(2):756-62
references: 12663454
references: Bone Marrow Transplant. 1996 Jun;17(6):1061-7
references: 8807115
references: Biol Blood Marrow Transplant. 2002;8(4):206-12
references: 12014809
references: Photodermatol Photoimmunol Photomed. 2008 Oct;24(5):268-9
references: 18811869
references: J Am Acad Dermatol. 1998 Mar;38(3):369-92; quiz 393-6
references: 9520019
references: N Engl J Med. 1997 Mar 27;336(13):897-904
references: 9070469
references: Arch Dermatol. 1998 Dec;134(12):1582-5
references: 9875197
references: Arch Dermatol. 2003 Feb;139(2):155-61
references: 12588221