2016 Volume 53 Issue 5 Pages 453-458
Sclerodermatous GVHD is a late effect of hematopoietic stem cell transplantation, which results in the impairment of the quality of a survivor’s life, and is difficult to manage. Most cases are often steroid-refractory and steroid-dependent sclerodermatous GVHD, and secondary treatment sometimes has limited efficacy. We performed a retrospective study on four sclerodermatous GVHD patients presenting severe joint contracture treated with narrow-band ultraviolet B (NB-UVB) from July 2012 to May 2015. All the patients had sclerodermatous grade 2 or higher according to the National Institutes of Health (NIH) grading, and showed less than 70% in the performance scale (PS). Three patients received steroid therapy, namely, two patients with steroid-refractory and one patient with steroid-dependent sclerodermatous GVHD. The remaining patient had a high possibility of acute myeloid leukemia relapse, favoring less immunosuppressant administration. We evaluated the responses of the patients with a photographic range of motion according to the NIH therapeutic response criteria. The observation period after irradiation was 718 days (range: 368–1039 days). A mean cumulative dose of 75 J/cm2 (range: 51–221 J/cm2) was applied in a mean number of 69 irradiations (range 53–159). All the patients showed improvement in the range of motion. The PS score was improved from a mean of 40% (pretreatment) to 75% (post-treatment). In western countries, extracorporeal photopheresis (ECP) is the mainstream secondary treatment for sclerodermatous GVHD, and its clinical trial is in progress in Japan. ECP is a promising treatment; however, there are a few problems, such as its high cost and facility accessibility in local areas. Therefore, NB-UVB can be an encouraging alternative to ECP for sclerodermatous GVHD.
