EFFICACY OF PHOTOTHERAPY FOR PATIENTS WITH CHRONIC GRAFT VERSUS HOST DISEASE

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.

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