Abstract
Chronic graft-versus host disease (cGVHD) occurs in 30% to 70% of patients undergoing allogeneic hematopoietic cell transplantation (HCT). Cutaneous cGVHD affects 75% of cGVHD patients, causing discomfort, limiting the range of movement, and increasing the risk of wound infections. Furthermore, systemic immunosuppression is often needed to treat cGVHD and long-term use can lead to adverse events. Optimal use of skin-directed therapies is integral to the management of cutaneous cGVHD and may decrease the amount of systemic immunosuppression required.This study reviewed English-language articles published from 1990 to 2017 that evaluated the effect of skin-directed treatments for cutaneous cGVHD. A total of 201 papers were identified, 164 articles were screened, 46 were read, and 18 publications were utilized in the review. Skin-directed treatments for cGVHD included topical steroids, topical calcineurin inhibitors, psoralen with ultraviolet A (PUVA) irradiation, ultraviolet A1 (UVA1) irradiation, and ultraviolet B (UVB) irradiation. We report the number of complete remissions, partial remissions, and systemic immunosuppression reduction in each study, as available.Twenty-two out of 30 (73.3%) patients experienced overall improvement with topical calcineurin inhibitors. At least 26 out of 76 patients (34.2%) receiving PUVA experienced complete remission, and 30 out of 76 patients (39.5%) experienced partial remission. In UVA1 studies, 44 out of 52 (84.6%) patients experienced overall improvement. In UVB studies, nine out of 14 patients (64.3%) experienced complete remission and four out of 14 patients (28.6%) experienced partial remission.As more HCTs are performed, more individuals will develop cGVHD. Awareness and optimal use of skin-directed therapies for cutaneous cGVHD may help improve patient outcomes and quality of life.
Highlights
BackgroundChronic graft-versus-host disease occurs in 30% to 70% of post-hematopoietic cell transplantation (HCT) patients [1,2]
This study reviewed English-language articles published from 1990 to 2017 that evaluated the effect of skindirected treatments for cutaneous Chronic graft-versus host disease (cGVHD)
Multiple systemic and topical therapies are available for cutaneous GVHD, and this study aims to provide an overview of available skindirected treatment for cutaneous manifestations of cGVHD [11,12]
Summary
Chronic graft-versus-host disease (cGVHD) occurs in 30% to 70% of post-hematopoietic cell transplantation (HCT) patients [1,2]. Case-matched controls, 10-year survivors of allogeneic HCT report a poorer quality of life, including greater discomfort or dysfunction during sexual activity, memory problems, and higher rates of antidepressant and anxiolytic use [3]. These issues are likely associated with cGVHD symptoms. Chronic GVHD is a type IV hypersensitivity reaction, which occurs when donor effector T-cells from the graft recognize the cells of the recipient as foreign [4]. Control of cGVHD is integral for preventing morbidity and mortality in allogeneic HCT patients, and supportive measures, including skin-directed therapies, can improve skin symptoms and quality of life in post-allogeneic HCT patients
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