Department of Dermatology, Sheba Medical Center, Tel HaShomer, Ramat Gan, 52621, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, 69978, Israel.
Int J Dermatol. 2023 Oct;62(10):1261-1265. doi: 10.1111/ijd.16806. Epub 2023 Aug 11.
Chronic graft-versus-host disease is a severe complication of allogeneic stem cell and bone marrow transplantation. First-line immunosuppressive agents, such as steroids, are used to prevent this disease; however, they have multiple side effects. Therefore, bath psoralen plus ultraviolet-A (PUVA) is an alternative second-line treatment. This study aimed to evaluate the clinical efficacy of bath PUVA for managing chronic graft-versus-host disease.
This retrospective, case-control study included 14 patients with extensive cutaneous chronic graft-versus-host disease, resistant to systemic corticosteroid, treated with bath PUVA. Major and partial responses were defined as clinical improvements of >70% and 50-70%, respectively. We analyzed the graft-versus-host disease clinical presentation and timing after allogeneic stem cell and bone marrow transplantation, bath PUVA doses, background diseases, additional treatments, and adverse effects.
We observed eight major (three lichenoid and five sclerodermatoid) and six partial (three lichenoid and three sclerodermatoid) responses after a mean of 28 treatment sessions. After 6 to 25 months, four of the eight patients with sclerodermatoid lesions and all those with lichenoid lesions experienced relapse but responded to additional treatment cycles.
Bath PUVA is well-tolerated and effective for extensive cutaneous chronic graft-versus-host disease. It allows rapid tapering of adjuvant immunosuppressants; however, most patients require prolonged maintenance phototherapy.
慢性移植物抗宿主病是异基因干细胞和骨髓移植的严重并发症。一线免疫抑制剂如皮质类固醇用于预防这种疾病；然而，它们有多种副作用。因此，沐浴补骨脂素加紫外线 A（PUVA）是替代二线治疗方法。本研究旨在评估沐浴 PUVA 治疗慢性移植物抗宿主病的临床疗效。
这是一项回顾性病例对照研究，纳入了 14 例广泛皮肤慢性移植物抗宿主病患者，这些患者对全身皮质类固醇耐药，接受了沐浴 PUVA 治疗。主要和部分反应分别定义为>70%和 50-70%的临床改善。我们分析了移植物抗宿主病的临床表现和发病时间、沐浴 PUVA 剂量、基础疾病、附加治疗和不良反应。
我们观察到在 28 次治疗后，有 8 例（3 例苔藓样和 5 例硬皮病样）和 6 例（3 例苔藓样和 3 例硬皮病样）主要（3 例苔藓样和 5 例硬皮病样）和部分（3 例苔藓样和 3 例硬皮病样）反应。在 6 至 25 个月后，8 例硬皮病样病变患者中有 4 例和所有苔藓样病变患者出现复发，但对额外的治疗周期有反应。
沐浴 PUVA 治疗广泛皮肤慢性移植物抗宿主病耐受性好，疗效确切。它可以迅速减少辅助免疫抑制剂的用量；然而，大多数患者需要长期维持光疗。
