D'incan M, Kanold J, Halle P, De Lumley L, Souteyrand P, Deméocq F
Service de Dermatologie, CHRU-Hôtel-Dieu, BP 69, 63001 Clermont-Ferrand Cedex 01, France.
Ann Dermatol Venereol. 2000 Feb;127(2):166-70.
Graft versus host reaction is a life-threatening complication of allogenic bone marrow transplantation. Extracorporeal photopheresis has been used for some years in the treatment of graft versus host reaction. We report on three children treated with extracorporeal photopheresis for a graft versus host reaction resistant to immunosuppresive drugs.
Three children with a graft versus host reaction were submitted to 18, 30 and 46 extracorporeal photopheresis courses respectively. In the same time, the other immunosuppressive treatments were tapered or definitively stopped (ciclosporin).
A dramatic improvement of cutaneous status and biological data was observed after the first courses. However, the extracorporeal photopheresis treatment did not improve the mucous lesions. No serious adverse effect was encountered.
As published elsewhere, extracorporeal photopheresis was effective on the graft versus host reaction lichenoid cutaneous lesions and in case of visceral involvement. In all of our cases, the immunosuppressive drug could have been tapered. No adverse event was observed. Thus, extracorporeal photopheresis should be indicated in case of resistance to immunosuppressive drugs.
移植物抗宿主反应是同种异体骨髓移植的一种危及生命的并发症。体外光化学疗法已用于治疗移植物抗宿主反应多年。我们报告了三名接受体外光化学疗法治疗的儿童，他们的移植物抗宿主反应对免疫抑制药物耐药。
三名患有移植物抗宿主反应的儿童分别接受了18、30和46个疗程的体外光化学疗法。同时，其他免疫抑制治疗逐渐减少或最终停止（环孢素）。
在第一个疗程后，观察到皮肤状况和生物学数据有显著改善。然而，体外光化学疗法治疗并未改善黏膜病变。未遇到严重不良反应。
正如其他地方所发表的，体外光化学疗法对移植物抗宿主反应性苔藓样皮肤病变以及内脏受累情况有效。在我们所有的病例中，免疫抑制药物本可以逐渐减少使用。未观察到不良事件。因此，在对免疫抑制药物耐药的情况下应采用体外光化学疗法。
