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Photochemotherapy of Cutaneous Graft-versus-Host Disease May Reduce Concomitant Visceral Disease.
- Source :
-
Dermatology (Basel, Switzerland) [Dermatology] 2016; Vol. 232 (4), pp. 453-63. Date of Electronic Publication: 2016 Jul 20. - Publication Year :
- 2016
-
Abstract
- Background: Photochemotherapy may be used to treat cutaneous graft-versus-host disease (GvHD). Animal models show that in the days after photochemotherapy and antigen provocation, cells with an antigen-specific suppressive phenotype are elicited in the lymphoid organs. In GvHD, host antigens are present not only in the skin treated by photochemotherapy but also in the visceral tissues.<br />Objective: The aim of this paper was to evaluate the effect on visceral acute GvHD (aGvHD) of photochemotherapy of the skin.<br />Methods: We retrospectively evaluated 33 patients with aGvHD of the skin, the liver, and/or the gastrointestinal tract treated with photochemotherapy for their aGvHD of the skin and did a long-term follow-up of 10 years on survival.<br />Results: The complete response (CR) to photochemotherapy was 39%, the complete and partial response was 64% and the 6-month survival was 64%. Total body irradiation (TBI) before hematopoietic stem cell transplantation predisposed for CR of aGvHD of the liver and the gastrointestinal tract (p = 0.045). In the TBI group, the accumulated dose (numbers of treatments) for CR of visceral aGvHD increased with the body surface area affected by disease, from 8 (min-max: 5-14) for skin disease stage 1 to 10.5 (6-33) for stage 2 and 13 (11-21) for stage 3 (p = 0.04). Skin disease stage 1 showed a trend to be associated with CR in visceral disease at 28, 56, and 100 days (p = 0.07). Overall CR in visceral disease predicted a better 10-year overall survival (p = 0.0036). Finally, after TBI aGvHD of the gastrointestinal tract without anti-thymocyte globulin (ATG), clearance of T cells and dendritic cells responded better than aGvHD of the liver and aGvHD of the gastrointestinal tract with ATG (p = 0.01).<br />Conclusion: Photochemotherapy after ionizing irradiation regulates the cell-mediated immunity in the viscera, and the systemic efficacy increases when the skin itself is less affected by disease. ATG modulates the regulatory effect of the gastrointestinal tract.<br /> (© 2016 S. Karger AG, Basel.)
- Subjects :
- Adolescent
Adult
Child
Child, Preschool
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Graft Survival
Graft vs Host Disease diagnosis
Graft vs Host Disease immunology
Humans
Infant
Male
Methoxsalen
Middle Aged
Photosensitizing Agents administration & dosage
Retrospective Studies
Skin pathology
Time Factors
Treatment Outcome
Young Adult
Glucocorticoids administration & dosage
Graft vs Host Disease therapy
Hematopoietic Stem Cell Transplantation methods
Immunity, Cellular
Photochemotherapy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1421-9832
- Volume :
- 232
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Dermatology (Basel, Switzerland)
- Publication Type :
- Academic Journal
- Accession number :
- 27433980
- Full Text :
- https://doi.org/10.1159/000447058