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Extracorporeal photochemotherapy for treatment of fasciitis in chronic graft-versus-host disease

Bone Marrow Transplantation volume 33, pages 869–870 (2004)Cite this article

Chronic graft-versus-host disease (cGVHD) affects 30–50% of hematopoietic stem cell transplant (HSCT) patients with skin involvement in about 70%. Among sclerodermiform manifestations, fasciitis, similar in many aspects to eosinophilic fasciitis, has rarely been reported as the only clinical sign of cGVHD.1,2 This form of fasciitis is unusual for several reasons: late onset (mean 841 days compared with 322 days for other cGVHD scleroses), beginning with edema rather than lichenoid papules, as is characteristic of other cutaneous manifestations, and failure to respond to steroids and other conventional treatment for cGVHD.2 Moreover, it differs in two aspects from all other forms of sclerodermiform cGVHD: (i) involvement of the muscle fascia, often without the dermal and epidermal involvement present in all other forms, and (ii) exclusively acral localisation.

The patient was treated with two consecutive sessions of extracorporeal photochemotherapy (ECP) every 2 weeks, while immunosuppressive therapy was continued. ECP was performed by UVAR® apparatus (Therakos, Westchester, PA, USA). At follow-up examination 3 months after the start of ECP (10th cycle), there was clear improvement of symptoms, with reduction of edema and improved movement of both elbows. The right shoulder was less stiff, but the left shoulder had not improved. At a subsequent follow-up at about 6 months (22nd cycle of ECP), movement of both the elbows had further improved: right elbow from 125° to 145° (Figure 1b) and left elbow from 108° to 114°. ECP enabled the dose of immunosuppressives to be reduced (cyclosporine 2.5 mg/kg/day and prednisone 20 mg/day). Blood tests after ECP treatment showed improvement in liver function indices, ESR (18 mm/h) and eosinophils (3.4%).

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  1. Department of Clinical Medicine and Immunological Science, Dermatology Section, University of Siena, Siena, Italy

    P Sbano, P Rubegni, G B De Aloe & M Fimiani

  2. Department of Haematology, Bone Marrow Transplant Service, Policlinico ‘Careggi’, Florence, Italy

    S Guidi

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Sbano, P., Rubegni, P., De Aloe, G. et al. Extracorporeal photochemotherapy for treatment of fasciitis in chronic graft-versus-host disease. Bone Marrow Transplant 33, 869–870 (2004). https://doi.org/10.1038/sj.bmt.1704436

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