Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Graft-Versus-Host Disease

Medium dose long-wavelength ultraviolet A (UVA1) phototherapy for the treatment of acute and chronic graft-versus-host disease of the skin

Bone Marrow Transplantation volume 35, pages 515–519 (2005)Cite this article

Summary:

Long-wavelength ultraviolet A (340–400 nm UVA1) phototherapy has been reported to be effective in atopic dermatitis, localized scleroderma and other T-cell-derived skin diseases. UVA1 as an adjunct to systemic immunosuppressive treatment was found to be safe, and effective in 10 patients with chronic cutaneous (seven lichenoid and three sclerodermoid) graft-versus-host disease (GVHD) after stem cell transplantation. Complete and partial responses were achieved in six (60%), and in three (30%) patients, respectively. One patient had improvement of sclerotic skin lesions. At a median follow-up of 14 months, two patients with lichenoid lesions relapsed. Both responded to another treatment cycle. Furthermore, we treated seven patients with UVA1 as primary therapy for acute cutaneous GVHD grades II and III in a pilot experience. Five patients had a complete response with no relapse at a median follow-up of 9 months after UVA1. Two patients showed no response and systemic steroids had to be started. UVA1 therapy is feasible, well tolerated and can be effective in treating chronic as well as acute GVHD confined to the skin thereby avoiding systemic steroids. Our results should be confirmed in larger studies and the effectiveness of UVA1 compared to other established treatment modalities.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Storb R, Deeg HJ, Whitehead J et al. Methotrexate and cyclosporine compared with cyclosporine alone for prophylaxis of acute graft-versus-host disease after marrow transplantation for leukemia. N Engl J Med 1986; 314: 729–735.

    Article  CAS  PubMed  Google Scholar 

  2. Beatty PG, Hanson JA, Longton GM et al. Marrow transplantation from HLA-matched unrelated donors for treatment of hematologic malignancies. Transplantation 1991; 51: 443–447.

    Article  CAS  PubMed  Google Scholar 

  3. Ringden O, Backman L, Lonnqvist B et al. A randomized trial comparing use of cyclosporin and methtrexate for prophylaxis of graft-versus-host disease in bone marrow transplant recipients with hematological malignancies. Bone Marrow Transplant 1986; 1: 41–51.

    CAS  PubMed  Google Scholar 

  4. Sullivan K, Agura E, Anasetti C . Chronic graft versus host disease and other late complications of bone marrow transplantation. Semin Hematol 1991; 28: 250–259.

    CAS  PubMed  Google Scholar 

  5. Vogelsang GB, Lee L, Bensen-Kennedy DM . Pathogenesis and treatment of graft-versus-host-disease after bone marrow transplant. Annu Rev Med 2003; 54: 29–52.

    Article  CAS  PubMed  Google Scholar 

  6. Simon JC, Pfleger D, Schopf E . Recent advances in phototherapy. Eur J Dermatol 2000; 10: 642–645.

    CAS  PubMed  Google Scholar 

  7. Dawe RS . Ultraviolet A1 phototherapy. Topical review. Br J Dermatol 2003; 148: 626–637.

    Article  CAS  PubMed  Google Scholar 

  8. Grundmann-Kollmann M, Behrens S, Gruss C et al. Chronic sclerodermic graft-versus-host disease refractory to immunosuppressive treatment responds to UVA1 phototherapy. J Am Acad Dermatol 2000; 42: 134–136.

    Article  CAS  PubMed  Google Scholar 

  9. Staender H, Schiller M, Schwarz T . UVA1 therapy for sclerodermic graft-versus-host disease of the skin. J Am Acad Dermatol 2002; 46: 799–800.

    Article  Google Scholar 

  10. Calzavara Pinton P, Porta F, Izzi T et al. Prospects for ultraviolet A1 phototherapy as a treatment for chronic cutaneous graft-versus-host disease. Haematologica 2003; 88: 1169–1175.

    PubMed  Google Scholar 

  11. Glucksberg H, Storb R, Fever A et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HLA matched sibling donors. Transplantation 1974; 18: 295–304.

    Article  CAS  PubMed  Google Scholar 

  12. Thomas ED, Storb R, Clift RA et al. Bone marrow transplantation. N Engl J Med 1975; 292: 895–902.

    Article  CAS  PubMed  Google Scholar 

  13. Doney KC, Weiden PL, Storb R et al. Treatment of graft-versus-host disease in human allogeneic marrow graft recipients: a randomized trial comparing antithymocyte globulin and corticosteroids. Am J Hematol 1981; 11: 1–8.

    Article  CAS  PubMed  Google Scholar 

  14. Arai S, Vogelsang GB . Management of graft-versus-host disease. Blood Rev 2000; 14: 190–204.

    Article  CAS  PubMed  Google Scholar 

  15. Aubin F, Brion A, Deconinck E et al. Phototherapy in the treatment of cutaneous graft-versus-host disease. Our preliminary experience in resistant patients. Transplantation 1995; 59: 151–155.

    Article  CAS  PubMed  Google Scholar 

  16. Eppinger T, Ehninger G, Steinert M et al. 8-Methoxypsoralen and ultraviolet A therapy for cutaneous manifestations of graft-versus-host disease. Transplantation 1990; 50: 807–811.

    Article  CAS  PubMed  Google Scholar 

  17. Leiter U, Kaskel P, Kraehn G et al. Psoralen plus ultraviolet-A-bath photochemotherapy as an adjunct treatment modality in cutaneous chronic graft versus host disease. Photodermatol Photoimmunol Photomed 2002; 18: 183–190.

    Article  CAS  PubMed  Google Scholar 

  18. Furlong T, Leisenring W, Storb R et al. Psoralen and ultraviolet A irradiation (PUVA) as therapy for steroid-resistant cutaneous acute graft-versus-host disease. Biol Blood Marrow Transplant 2002; 8: 206–212.

    Article  CAS  PubMed  Google Scholar 

  19. Wiesmann A, Weller A, Lischka G et al. Treatment of acute graft-versus-host disease with PUVA (psoralen and ultraviolet irradiation): results of a pilot study. Bone Marrow Transplant 1999; 23: 151–155.

    Article  CAS  PubMed  Google Scholar 

  20. Reinauer S, Lehmann P, Plewig G et al. Photochemotherapy (PUVA) of acute graft-versus-host disease. Hautarzt 1993; 44: 708–712.

    CAS  PubMed  Google Scholar 

  21. Wetzig T, Al-Ali HK, Kirstner S et al. Primary PUVA phototherapy can be effective for acute graft-versus-host disease of the skin. Bone Marrow Transplant 2004; 33: 183 (Abstract).

    Article  Google Scholar 

  22. Greinix HT, Volc-Platzer B, Kahls P et al. Extracorporeal photochemotherapy in the treatment of severe steroid-refractory acute graft-versus-host disease: a pilot study. Blood 2000; 96: 2426–2431.

    CAS  PubMed  Google Scholar 

  23. Greinix HT, Volc-Platzer B, Rabitsch W et al. Successful use of extracorporeal photochemotherapy in the treatment of severe acute and chronic graft-versus-host disease. Blood 1998; 92: 3098–3104.

    CAS  PubMed  Google Scholar 

  24. Morita A, Werfel T, Stege H et al. Evidence that singlet oxygen-induced human T helper cell apoptosis is the basic mechanism of ultraviolet-A radiation phototherapy. J Exp Med 1997; 186: 1763–1768.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Grewe M, Gyufko K, Schopf E et al. Lesional expression of interferon-ã in atopic eczema. Lancet 1994; 343: 25–26.

    Article  CAS  PubMed  Google Scholar 

  26. Krutmann J . Ultraviolet A radiation-induced immunomodulation: molecular and photobiological mechanisms. Eur J Dermatol 1998; 8: 200–202.

    CAS  PubMed  Google Scholar 

  27. Petersen MJ, Hansen C, Craig S . Ultraviolet A irradiation stimulates collagenase production in cultured human fibroblasts. J Invest Dermatol 1992; 99: 440–444.

    Article  CAS  PubMed  Google Scholar 

  28. van Kranen HJ, de Laat A, van de Ven J et al. Low incidence of p53 mutations in UVA (365-nm)-induced skin tumors in hairless mice. Cancer Res 1997; 57: 1238–1240.

    CAS  PubMed  Google Scholar 

  29. Wallenfang K, Stadler R . Assoziation zwischen UVA1 bzw. Bade-PUVA-Bestrahlung und Melanomentwicklung? Hautarzt 2001; 52: 705–707.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, University of Leipzig, Germany

    T Wetzig, M Sticherling & J-C Simon

  2. Division of Hematology/Oncology, University of Leipzig, Germany

    U Hegenbart, D Niederwieser & H K Al-Ali

Authors
  1. T Wetzig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Sticherling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J-C Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U Hegenbart
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D Niederwieser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H K Al-Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H K Al-Ali.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wetzig, T., Sticherling, M., Simon, JC. et al. Medium dose long-wavelength ultraviolet A (UVA1) phototherapy for the treatment of acute and chronic graft-versus-host disease of the skin. Bone Marrow Transplant 35, 515–519 (2005). https://doi.org/10.1038/sj.bmt.1704804

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1704804

Keywords

This article is cited by

Search

Advanced search

Quick links