Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, 06560, Turkey.
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, 06560, Turkey.
Curr Res Transl Med. 2020 Jan;68(1):1-4. doi: 10.1016/j.retram.2019.11.001. Epub 2019 Nov 21.
Graft-versus-host disease (GvHD) is a common complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with high morbidity and mortality rates. The purpose of this study was to demonstrate the efficacy of Manual Lymph Drainage (MLD) and a home-based exercise programme on range of motion (ROM) and flexibility in a patient diagnosed with chronic cutaneous GvHD. A 29-year-old male who was diagnosed as acute lymphoblastic leukemia underwent allo-HSCT after induction chemotherapy. He developed extended chronic cutaneous skin GvHD. He received systemic immunosuppressive treatment and Psoralen and ultraviolet radiation (PUVA) for 20 sessions. He was then consulted to physiotherapy department for the limitation of multiple ROM due to severe GvHD. The range of motions of shoulder, elbow, hip, knee and ankle joints were evaluated with universal goniometer. The chair sit, reach and back scratch tests were performed. MLD was applied for 2 weeks. Additionally, exercise recommendations were maintained as a home-programme. After the therapy, ROM values were better in wrist extension and hip abduction/adduction and the back scratch test result improved. According to chair sit and reach tests, the results decreased from 25 to 22cm distance after 2 weeks. With MLD treatment with exercise, ROM has been preserved and even improved in this refractory case. In addition, the flexibility test results were found to be increased. The efficacy of MLD and exercise in chronic cutaneous GvHD should be investigated in further studies.
移植物抗宿主病（GVHD）是异基因造血干细胞移植（allo-HSCT）的常见并发症，具有较高的发病率和死亡率。本研究旨在证明手动淋巴引流（MLD）和家庭运动方案对慢性皮肤 GVHD 患者的关节活动度（ROM）和柔韧性的疗效。一名 29 岁男性，被诊断为急性淋巴细胞白血病，在诱导化疗后接受 allo-HSCT。他患有广泛的慢性皮肤 GVHD。他接受了全身免疫抑制治疗和补骨脂素和紫外线辐射（PUVA）治疗 20 次。由于严重的 GVHD，他被转诊到物理治疗科治疗多个 ROM 受限的问题。使用通用量角器评估肩关节、肘关节、髋关节、膝关节和踝关节的活动度。进行椅子坐、伸手和背部抓挠测试。进行了为期 2 周的 MLD 治疗。此外，还维持了运动建议作为家庭方案。治疗后，腕关节伸展和髋关节外展/内收的 ROM 值更好，背部抓挠测试结果有所改善。根据椅子坐和伸手测试，2 周后距离从 25 厘米下降到 22 厘米。通过 MLD 治疗和运动，在这种难治性病例中保持甚至改善了 ROM。此外，柔韧性测试结果也有所增加。应在进一步的研究中探讨 MLD 和运动在慢性皮肤 GVHD 中的疗效。
