Psoralen and ultraviolet A irradiation (PUVA) as therapy for steroid-resistant cutaneous acute graft-versus-host disease
Psoralen and ultraviolet A irradiation (PUVA) as therapy for steroid-resistant cutaneous acute graft-versus-host disease
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DOI：
10.1053/bbmt.2002.v8.pm12014809
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发表时间：
2002-01-01
影响因子：
4.3
通讯作者：
Martin, PJ
中科院分区：
文献类型：
--
作者：
Furlong, T;Leisenring, W;Martin, PJ
补骨脂素加紫外线照射（PUVA）具有免疫调节作用，可用于治疗多种免疫介导的皮肤病。我们对103例皮肤类固醇抵抗性急性移植物抗宿主病（GVHD）患者给予PUVA治疗。29例患者有亲属供者（12例hla错配），74例患者无亲属供者（23例hla错配）。GVHD的中位发病时间为移植后第13天，PUVA治疗的中位发病时间为第46天。86例患者接受PUVA辅助治疗，17例患者接受三级或以上治疗。处理次数中位数为16次，平均累积暴露量为41 J/cm(2)。PUVA一般耐受良好，8例患者因毒性而停止治疗。在PUVA治疗开始时，48例患者出现皮疹，影响其体表面积（BSA）的50%，91例患者出现皮疹，影响BSA的25%。在接受PUVA治疗6周后评估的65名患者中，11名患者仍有皮疹，涉及>50% BSA， 24名患者有皮疹，涉及>25% BSA， 24名患者无皮疹。在PUVA治疗开始时，泼尼松的平均日剂量为1.6 mg/kg，而治疗6周后为0.7 mg/kg。59例（57%）患者在开始PUVA治疗后不需要额外的皮肤GVHD治疗。90%的患者发展为慢性GVHD。53例患者（51%）在移植后129-1883天存活。这些结果表明，PUVA可能是一种有效的治疗类固醇抵抗急性GVHD皮肤。
Psoralen plus ultraviolet A irradiation (PUVA) has immunomodulatory effects and is used to treat a variety of immune-mediated dermatologic diseases. We administered PUVA to 103 patients for treatment of steroid-resistant acute graft-versus-host disease (GVHD) of the skin. Twenty-nine patients had related donors (12 HLA-mismatched) and 74 had unrelated donors (23 HLA-mismatched). The median onset of GVHD was day 13 after transplantation, and the median onset of PUVA treatment was day 46. PUVA was administered as secondary therapy for 86 patients and tertiary therapy or greater for 17 patients. The median number of treatments was 16, and the mean cumulative exposure was 41 J/cm(2). PUVA was generally well tolerated with 8 patients discontinuing therapy because of toxicity. At the start of PUVA treatment, 48 patients had rash affecting >50% of their body surface area (BSA), and 91 had rash involving >25% BSA. Of 65 patients who were evaluated after 6 weeks of PUVA treatment, 11 still had rash involving >50% BSA, 24 had rash involving >25% BSA, and 24 had no rash. The mean daily dose of prednisone at the start of PUVA therapy was 1.6 mg/kg compared to 0.7 mg/kg after 6 weeks of therapy. Fifty-nine patients (57%) did not require additional therapy for skin GVHD after starting PUVA. Ninety-tvvo percent of patients developed chronic GVHD. Fifty-three patients (51%) remain alive at 129-1883 days after transplantation. These results suggest that PUVA can be an effective therapy for steroid-resistant acute GVHD of the skin.