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Efficacy of narrow band UVB in the treatment of cutaneous GvHD: an Indian experience

Bone Marrow Transplantation volume 51, pages 988–990 (2016)Cite this article

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Acute GvHD occurs in >50% of patients1 and mainly affects the skin, gastrointestinal (GI) tract and liver. If skin is the predominant or the only organ involved, skin-directed therapy such as phototherapy is an option. Phototherapy has been used mainly as an adjuvant treatment in steroid-refractory or steroid-dependent GvHD, with responses varying from 50 to 100%.2, 3 Psoralen with UVA (PUVA) has been shown to be efficacious in both acute and chronic GvHD;4, 5, 6 however, the theoretical risk of skin cancer and potential hepatic toxicity has prompted the use of narrow band UVB (NBUVB) in cutaneous GvHD with proven efficacy in a few series of acute GvHD and overlap syndromes recently in adults and children.7, 8 In this retrospective study, we analyzed the efficacy of NBUVB as a treatment option in acute cutaneous GVHD.

Twenty patients who received NBUVB phototherapy for the treatment of acute GvHD following stem cell transplantation (SCT) with predominant skin manifestations between May 2010 and June 2013 were studied after approval by the institutional review board. During this period, 420 patients underwent SCT of which 153 (36.4%) developed acute GvHD and 120 (28.5%) had skin GvHD. The diagnosis of acute GvHD was based on clinical criteria supported by biopsy (n=18) and on clinical criteria alone (n=2) after excluding other etiologies such as viral exanthems and drug rashes. Transient rashes lasting <72 h were excluded. Clinical staging was done according to the Glucksberg criteria.9

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References

  1. Ferrara JL, Levine JE, Reddy P, Holler E . Graft-versus-host-disease. Lancet 2009; 373: 1550–1561.

    Article  CAS  Google Scholar 

  2. Enk CD, Elad S, Vexler A, Kapelushnik J, Gorodetsky R, Kirschbaum M . Chronic graft-versus-host-disease treated with UVB phototherapy. Bone Marrow Transplant 1998; 22: 1179–1183.

    Article  CAS  Google Scholar 

  3. Brazzelli V, Grasso V, Muzio F, Moggio E, Zecca M, Locatelli F et al. Narrowband ultraviolet B phototherapy in the treatment of cutaneous graft versus host disease in oncohaematological paediatric patients. Br J Dermatol 2010; 162: 404–409.

    Article  CAS  Google Scholar 

  4. Furlong T, Leisenring W, Storb R, Anasetti C, Appelbaum FR, Carpenter PA 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  Google Scholar 

  5. Vogelsang GB, Wolff D, Altomonte VA, Farmer E, Morison WL, Corio R et al. Treatment of chronic graft versus host disease with ultraviolet irradiation and Psoralen (PUVA). Bone Marrow Transplant 1996; 17: 1061–1067.

    CAS  PubMed  Google Scholar 

  6. Wiesmann A, Weller A, Lischka G, Klingebiel T, Kanz L, Einsele H . 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  Google Scholar 

  7. Feldstein JV, Bolanos-Maede J, Anders VL, Abnav R . Narrowband ultraviolet B phototherapy for the treatment of steroid refractory and steroid dependent acute graft versus –host disease of the skin. J Am Acad Dermatol 2011; 65: 733–738.

    Article  CAS  Google Scholar 

  8. Grundmann-Kollmann M, Martin H, Ludwig R, Klein S, Boehncke WH, Hoelzer D et al. Narrowband UV-B phototherapy in the treatment of cutaneous graft versus host disease. Transplantation 2002; 74: 1631–1634.

    Article  CAS  Google Scholar 

  9. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. 1994 consensus conference on AGvHD grading. Bone Marrow Transplant 1995; 15: 825–828.

    CAS  Google Scholar 

  10. Schlaak M, Schwind S, Wetzig T, Maschke J, Treudler R, Basara N et al. UVA (UVA- 1) therapy for the treatment of acute GvHD of the skin. Bone Marrow Transplant 2010; 45: 1741–1748.

    Article  CAS  Google Scholar 

  11. Iyama S, Murase K, Sato T, Hashimoto A, Tatekoshi A, Horiguchi H et al. Narrowband ultraviolet B phototherapy ameliorates acute graft-versus-host disease by a mechanism involving in vivo expansion of CD4+CD25+Foxp3+ regulatory T cells. Int J Hematol 2014; 99: 471–476.

    Article  CAS  Google Scholar 

  12. Kreutz M, Karrer S, Hoffmann P, Gottfried E, Szeimies RM, Hahn J et al. Whole-body UVB irradiation during allogeneic hematopoietic cell transplantation is safe and decreases acute Graft-versus-host disease. J Invest Dermatol 2012; 132: 179–187.

    Article  CAS  Google Scholar 

  13. Jampel RM, Farmer ER, Vogelsang GB, Wingard J, Santos GW, Morison WL . PUVA therapy for chronic cutaneous graft-vs-host disease. Arch Dermatol 1991; 127: 1673–1678.

    Article  CAS  Google Scholar 

  14. Aubin F, Brion A, Deconinck E, Plouvier E, Hervé P, Humbert P 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  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, India

    L George, D Peter, M Chopra & S A Pulimood

  2. Department of Haematology, Christian Medical College, Vellore, India

    B George, A Abraham, V Mathews & A Srivastava

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  1. L George
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  2. D Peter
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  8. S A Pulimood
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Correspondence to L George.

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George, L., Peter, D., Chopra, M. et al. Efficacy of narrow band UVB in the treatment of cutaneous GvHD: an Indian experience. Bone Marrow Transplant 51, 988–990 (2016). https://doi.org/10.1038/bmt.2016.13

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