Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel.
Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel.
Photodermatol Photoimmunol Photomed. 2024 Sep;40(5):e12997. doi: 10.1111/phpp.12997.
Cutaneous graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic stem cell transplantation. Phototherapy has been used to treat cutaneous GVHD, but data on its safety and efficacy are sparse.
Review the current medical literature regarding the efficacy, dosing, and safety of various types of phototherapies for the treatment of cutaneous GVHD.
A systematic review of PubMed, Embase, Cochrane, and ClinicalTrials databases was performed. Publications were screened according to the PRISMA guidelines. Exclusion criteria comprised case reports and case series reporting less than five patients, review articles, and articles not published in English.
A total of 28/1304 (2.5%) studies were included. Fifteen studies (n = 267 patients) focused on psoralen and ultraviolet (UV) A (PUVA), in which 65.5% of patients received concomitantly other systemic treatments. The response rate was 89.9%, with a mean of 33.2 treatments. Adverse events were recorded in 54% but were mainly mild. Eight studies, encompassing 95 patients, focused on narrow-band (NB) UVB. A response was observed in 94%, with a mean number of 26 treatments and 8.6% adverse effects. UVA1 was reported in six studies (n = 132 patients). A response was recorded in 89.3% with a mean of 26.2 treatments. Adverse events were noted in 70.1%, with a discontinuation rate of 10.9%. It should be noted that adverse events were recorded during the follow-up period of the studies, which varied significantly, ranging from no follow-up to 31 months.
Current data regarding the use of phototherapy for the treatment of cutaneous GVHD are based on retrospective studies and case series. The present report advocates the use of one of the three modalities of phototherapy as an effective and safe adjunctive treatment for cutaneous GVHD, especially NB UVB phototherapy.
皮肤移植物抗宿主病（GVHD）是异基因造血干细胞移植的常见并发症。光疗已被用于治疗皮肤 GVHD，但关于其安全性和疗效的数据很少。
综述目前关于各种光疗治疗皮肤 GVHD 的疗效、剂量和安全性的医学文献。
对 PubMed、Embase、Cochrane 和 ClinicalTrials 数据库进行系统综述。根据 PRISMA 指南筛选出版物。排除标准包括少于 5 例患者的病例报告和病例系列报告、综述文章以及未以英文发表的文章。
共纳入 28/1304（2.5%）项研究。15 项研究（n=267 例患者）侧重于补骨脂素和紫外线 A（PUVA），其中 65.5%的患者同时接受其他全身治疗。反应率为 89.9%，平均治疗 33.2 次。记录了 54%的不良事件，但主要为轻度。8 项研究，共 95 例患者，侧重于窄带（NB）UVB。观察到 94%的反应，平均治疗 26 次，不良事件发生率为 8.6%。有 6 项研究（n=132 例）报道了 UVA1。记录到 89.3%的反应，平均治疗 26.2 次。不良事件发生率为 70.1%，停药率为 10.9%。应当注意的是，不良事件是在研究的随访期间记录的，随访时间差异很大，从无随访到 31 个月不等。
目前关于光疗治疗皮肤 GVHD 的使用数据基于回顾性研究和病例系列。本报告主张使用三种光疗方式之一作为皮肤 GVHD 的有效且安全的辅助治疗方法，特别是 NB UVB 光疗。
