bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.18821/0234-5730-2017-62-2-83-89bloodjour-67Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESЭФФЕКТИВНОСТЬ ФОТОТЕРАПИИ ПРИ ХРОНИЧЕСКОЙ РЕАКЦИИ «ТРАНСПЛАНТАТ ПРОТИВ ХОЗЯИНА»EFFICACY OF PHOTOTHERAPY FOR PATIENTS WITH CHRONIC GRAFT VERSUS HOST DISEASEhttps://orcid.org/0000-0002-8363-5188ВолнухинВ. A.VolnukhinV. A.

107076, г. Москва

Волнухин Владимир Анатольевич, доктор мед. наук, профессор, ведущий научный сотрудник отдела дерматологии

Moscow, 107076

Volnukhin Vladimir A., MD, PhD, leading researcher of the dermatology departmen

vvoln@rambler.ruhttps://orcid.org/0000-0001-6201-6276КузьминаЛ. A.KuzminaL. A.https://orcid.org/0000-0003-0904-7385ВасильеваВ. A.VasilievaV. A.https://orcid.org/0000-0002-2253-98ДубнякД. С.DubnyakD. S.https://orcid.org/0000-0001-6177-3566ПаровичниковаE. Н.ParovichnikovaE. N.https://orcid.org/0000-0001-8188-5557СавченкоВ. Г.SavchenkoV. G.ФГБУ «Государственный научный центр дерматовенерологии и косметологии» Минздрава РоссииРоссияState Research Center of Dermatovenereology and CosmetologyRussian FederationФГБУ «Гематологический научный центр» Минздрава РоссииРоссияNational Research Сenter for HematologyRussian Federation2017120320196228389Copyright © Волнухин В.A., Кузьмина Л.A., Васильева В.A., Дубняк Д.С., Паровичникова E.Н., Савченко В.Г., 20192019Волнухин В.A., Кузьмина Л.A., Васильева В.A., Дубняк Д.С., Паровичникова E.Н., Савченко В.Г.Volnukhin V.A., Kuzmina L.A., Vasilieva V.A., Dubnyak D.S., Parovichnikova E.N., Savchenko V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/67

Цель исследования – изучить эффективность лечения кожных проявлений хронической реакции «трансплантат против хозяина» (хРТПХ) у больных, резистентных к глюкокортикоидным и иммуносупрессивным средствам, методами фототерапии (УФА1- и ПУВА-терапии). Проведен ретроспективный анализ результатов фототерапии у 12 больных с проявлениями хРТПХ, из них у 2 – лихеноидного типа, у 10 – склеродермоподобного типа. УФА1-терапию получали 9 больных, ПУВА-терапию – 1 больной, поэтапно ПУВА и УФА1-терапию – 2 больных. Фототерапию в комбинации с глюкокортикоидными и иммуносупрессивными препаратами проводили у 10 больных, в виде монотерапии – у 2. В результате проведенного лечения положительный эффект наблюдали у 10 (83%) больных, из них частичный ответ (уменьшение площади поражения кожи более чем на 50%) достигнут у 4 (33%) больных, клиническое улучшение (уменьшение площади поражения кожи на 15–50%) - у 6 (50%). Отсутствие эффекта (уменьшение площади поражения кожи менее чем на 15%) установлено у 2 больных. Под действием фототерапии наблюдалась положительная динамика в виде как уменьшения воспалительных изменений (эритема, пятнисто-папулезные высыпания), так и склероза кожи. У 7 (58%) больных прекратилось прогрессирование кожных проявлений хРТПХ. У 4 (33%) больных фототерапия позволила уменьшить дозу применявшихся глюкокортикоидных и иммуносупрессивных препаратов или добиться полной их отмены. Переносимость лечения была удовлетворительной, серьезных побочных эффектов не отмечено. При последующем наблюдении в сроки от 1 года до 12 лет (в среднем в течение 4 лет) 3 больных умерли (1 больная вследствие рецидива основного заболевания, 2 больных в результате развития осложнений хРТПХ). В настоящее время живы 9 больных, из них у 6 (67%) признаки прогрессирования кожного процесса отсутствовали. Ни у одного из больных мы не наблюдали развития рака кожи после фототерапии, в том числе при проведении нескольких курсов лечения, включавших большое количество процедур (60–136). УФА1- и ПУВА-терапия являются эффективными методами лечения кожных проявлений хРТПХ у больных, резистентных к глюкокортикоидным и иммуносупрессивным средствам.

The aim of the study was to assess the efficacy of the phototherapy (UVA1 therapy and PUVA therapy) for the resistance to glucocorticosteroid and immunosuppressive treatment of cutaneous form of chronic graftversus-host disease (chGVHD). The analysis of results of the phototherapy was performed. Twelve patients were included ih the study (2 patients with lichenoid type and 10 patients with scleroderma-like type (n = 10) of chGVHD. The patients were treated with the phototherapy including UVA1 therapy (n = 9), PUVA therapy (n = 1), PUVA therapy and UVA1 therapy stepwise (n = 2). In 10 patients the phototherapy was combined with steroid and immunosuppressive therapy, 2 patients received phototherapy as a monotherapy. 10 (83%) patients responded to the phototherapy. The reduction more than 50% of skin lesions achieved in 4 (33%) patients. Reduction of the affected area on 15–50% was observed in 6 (50%) patients and was identified as the clinical improvement. There was no effect of the treatment in case of the reduction less than 15% of skin lesions and that was observed in 2 patients. Skin inflammation (erythema, maculopapular rash) and sclerosis decreased under the phototherapy. Progression of cutaneous manifestations in chGVHD was interrupted in 7 (58%) patients. Reduction or withdrawal of steroid or immunosuppressive therapy due to phototherapy was achieved in 4 patients. Tolerability of UVA1 therapy and PUVA therapy was sufficient, and no adverse effect was observed. Patients were followed for 1 to 12 years (average: 4 years). One patient died due to the relapse of hematological disease, two patients died due to severe complications of chGVHD, others 9 patients are alive. No progression of cutaneous manifestations of chGVHD was observed in 6 (67%) alive patients. None of the patients developed skin cancer after phototherapy, even after several courses of treatment including a large number of procedures (60–136 procedures). Conclusion UVA1 therapy and PUVA therapy are effective methods of the treatment for patients with cutaneous manifestations of chGVHD which are resistant steroid and immunosuppressive therapy.

хроническая реакция «трансплантат против хозяина»поражение кожиУФА1-терапияПУВА-терапияэффективность леченияchronic graft-versus-host disease (chGVHD)cutaneous manifestationsUVA1 therapyPUVA therapyefficacyReferencesСавченко В.Г., Любимова Л.С., Паровичникова Е.Н., Менделеева Л.П., Момотюк К.С., Демидова И.А. и др. Трансплантации аллогенных и аутологичных гемопоэтических стволовых клеток при острых лейкозах (итоги 20-летнего опыта). Терапевтический архив. 2007; 79(7): 30–5.Savchenko V.G., Lyubimova L.S., Parovichnikova E.N., Mendeleeva L.P., Momotyuk K.S., Demidova I.A., et al. Transplantations of allogenic and autologous hemopoietic stem cells in acute leukemia (results of 20-year experience). Therapeutic archive. Russian Journal (Terapevticheskiy Arkhiv). 2007; 79(7): 30–5. (in Russian)Любимова Л.С., Кузьмина Л.А., Урнова Е.С., Желнова Е.И., Анухина М.В., Менделеева Л.П. и др. 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The authors declare that there are no conflicts of interest present.