Treatment of chronic cutaneous graft versus host disease (GVHD) with photochemotherapy with Psoralen (PUVA): A report of five cases

Chronic graft versus host disease (GVHD) remains the most common late complication of allogenic stem cell transplantation and the most frequent cause of morbidity and mortality in these patients. To control this condition, immunosuppressive drugs are usually administered at a high dose and for a long time, which may result in several side effects. 5 patients with clinically and histopathologically established cGVHD (3 lichenoid, 1 sclerodermoid and 1 mixed lichenoid-sclerodermoid), who failed to respond to conventional immunosuppressive therapy were treated with psoralen and UVA (PUVA). Treatment was administered in a standard protocol three times a week on non-consecutive days and were continued at least for 12 weeks. All 3 lichenoid cases showed complete improvement. In the sclerodermoid case there was partial response and in the mixed type case the partial response of sclerodermoid lesion and complete response of lichenoid lesions were observed. With the exception of a slight increase in liver transferases, no other adverse reactions occurred. In conclusion, PUVA can be a safe and effective therapy in conjunction with systemic agents for chronic GVHD especially in lichenoid form.