背景:皮肤移植物抗宿主病(GVHD)是异基因造血干细胞移植的常见并发症。光疗已被用于治疗皮肤GVHD,但有关其安全性和有效性的数据很少.
目的:回顾当前有关疗效的医学文献,给药,以及用于治疗皮肤GVHD的各种类型的光疗的安全性。
方法:对PubMed,Embase,科克伦,并进行临床试验数据库。根据PRISMA指南筛选出版物。排除标准包括病例报告和病例系列报告少于五名患者,评论文章,以及没有用英文发表的文章。
结果:共纳入28/1304(2.5%)研究。15项研究(n=267名患者)集中于补骨脂素和紫外线(UV)A(PUVA),其中65.5%的患者同时接受其他系统治疗。有效率为89.9%,平均33.2次治疗。不良事件记录为54%,但主要是轻度的。八项研究,包括95名患者,专注于窄带(NB)UVB。在94%中观察到反应,平均26种治疗方法和8.6%的不良反应。在6项研究中报道了UVA1(n=132例患者)。记录的反应为89.3%,平均为26.2次治疗。不良事件占70.1%,停药率为10.9%。应该注意的是,在研究的随访期间记录了不良事件,差异很大,从无随访到31个月不等。
结论:关于使用光疗治疗皮肤GVHD的现有数据基于回顾性研究和病例系列。本报告提倡使用三种光疗方式之一作为皮肤GVHD的有效和安全的辅助治疗,尤其是NBUVB光疗。
BACKGROUND: Cutaneous graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic stem cell transplantation. Phototherapy has been used to treat cutaneous GVHD, but data on its safety and efficacy are sparse.
OBJECTIVE: Review the current medical literature regarding the efficacy, dosing, and safety of various types of phototherapies for the treatment of cutaneous GVHD.
METHODS: A systematic review of PubMed, Embase, Cochrane, and ClinicalTrials databases was performed. Publications were screened according to the PRISMA guidelines. Exclusion criteria comprised case reports and case series reporting less than five patients, review articles, and articles not published in English.
RESULTS: A total of 28/1304 (2.5%) studies were included. Fifteen studies (n = 267 patients) focused on psoralen and ultraviolet (UV) A (PUVA), in which 65.5% of patients received concomitantly other systemic treatments. The response rate was 89.9%, with a mean of 33.2 treatments. Adverse events were recorded in 54% but were mainly mild. Eight studies, encompassing 95 patients, focused on narrow-band (NB) UVB. A response was observed in 94%, with a mean number of 26 treatments and 8.6% adverse effects. UVA1 was reported in six studies (n = 132 patients). A response was recorded in 89.3% with a mean of 26.2 treatments. Adverse events were noted in 70.1%, with a discontinuation rate of 10.9%. It should be noted that adverse events were recorded during the follow-up period of the studies, which varied significantly, ranging from no follow-up to 31 months.
CONCLUSIONS: Current data regarding the use of phototherapy for the treatment of cutaneous GVHD are based on retrospective studies and case series. The present report advocates the use of one of the three modalities of phototherapy as an effective and safe adjunctive treatment for cutaneous GVHD, especially NB UVB phototherapy.