Actas Dermo-Sifiliográficas (English Edition) Actas Dermo-Sifiliográficas (English Edition)
Actas Dermosifiliogr 2015;106:651-7 - Vol. 106 Num.8 DOI: 10.1016/j.adengl.2015.07.020
Original Article
The Role of Phototherapy in Cutaneous Chronic Graft-vs-Host Disease: A Retrospective Study and Review of the Literature
Análisis retrospectivo del papel de la fototerapia en la enfermedad injerto contra huésped crónica cutánea. Revisión de la literatura
R. Ballester-Sáncheza,, , M.Á. Navarro-Miraa, B. de Unamuno-Bustosa, C. Pujol-Marcoa, J. Sanz-Caballerb, R. Botella-Estradaa
a Servicio de Dermatología, Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Spain
b Servicio de Hematología, Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Spain
Received 09 March 2015, Accepted 20 April 2015
Abstract
Introduction and objectives

Cutaneous chronic graft-vs-host disease (GVHD) is a common complication of hematopoietic stem cell transplantation. Phototherapy is a therapeutic option for patients with skin involvement and for those who require high doses of corticosteroids. We analyze the cases treated in our department and review the literature.

Material and methods

All patients with GVHD treated with phototherapy in the dermatology department of Hospital Universitario y Politécnico la Fe in Valencia, Spain between March 2011 and October 2014 were identified. Data were gathered retrospectively.

Results

There were 16 patients: 10 treated with psoralen–UV-A and 6 with narrowband–UV-B. Complete response was achieved in 9 patients and partial response in 7; 2 patients with partial responses relapsed after treatment. Ten patients were able to decrease their dose of corticosteroids during treatment, and a further 3 decreased the number of other immunosuppressant drugs. No serious adverse effects occurred.

Conclusions

Phototherapy is a good therapeutic option for patients with chronic GVHD with extensive cutaneous involvement, as well as for those who fail to respond to topical treatment or who have become steroid-dependent. The main benefits are that, as the treatment targets the skin, it reduces corticosteroid requirements and has a good safety profile. Treatment must be individualized and, in our experience, both the initial dose and the maximum dose per session can be lower than for other diseases.

Resumen
Introducción y objetivos

La enfermedad injerto contra huésped (EICH) crónica cutánea es una complicación frecuente tras un trasplante de progenitores hematopoyéticos. La fototerapia es una modalidad terapéutica para pacientes con afectación cutánea o para aquellos que precisan altas dosis de corticoesteroides (CE). El objetivo de este estudio es revisar los casos tratados en nuestro servicio y hacer una revisión de la literatura.

Material y métodos

Recogida de datos de manera retrospectiva de todos los casos tratados desde marzo de 2011 a octubre de 2014 en el Servicio de Dermatología del Hospital Universitario y Politécnico la Fe de Valencia.

Resultados

Recogimos un total de 16 pacientes, 10 tratados con PUVA y 6 con UVB-BE. Nueve pacientes obtuvieron una respuesta completa y 7 una respuesta parcial, aunque 2 recidivaron tras el tratamiento. Diez pacientes pudieron disminuir la dosis de CE durante el tratamiento y 3 pudieron disminuir el número de otros inmunosupresores. No se presentaron efectos adversos graves.

Conclusiones

La fototerapia es una buena opción terapéutica para pacientes con EICH crónica con gran afectación cutánea, para aquellos que no responden al tratamiento tópico o para pacientes corticodependientes. Su mayor beneficio es el de ser un tratamiento dirigido a la piel que permite ahorrar CE y que presenta un buen perfil de seguridad. La pauta de tratamiento se realiza de manera individualizada y, según nuestra experiencia, con dosis iniciales y dosis máximas por sesión menores que para otras enfermedades.

Keywords
Cutaneous chronic graft-vs-host disease, Phototherapy, Psoralen–UV-A, Narrowband–UV-B
Palabras clave
Enfermedad injerto contra huésped crónica cutánea, Fototerapia, PUVA, UVB-BE

Article

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Actas Dermosifiliogr 2015;106:651-7 - Vol. 106 Num.8 DOI: 10.1016/j.adengl.2015.07.020
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