Phototherapy for the Treatment of Acute and Chronic Cutaneous Graft versus Host Disease.

Abstract

Background: Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic cell transplantation (allo-HCT) and commonly exhibits cutaneous involvement. Topical and systemic therapies are frequently utilized to treat cutaneous GVHD, however these treatments are often limited by toxicity, incomplete response, and poor tolerability. Phototherapy has shown potential benefit as an adjunct treatment for cutaneous GVHD, although prior research has been limited to small retrospective studies.

Objective: Evaluate the efficacy and safety of ultraviolet (UV)-based phototherapy in the treatment of cutaneous acute GVHD (aGVHD) and chronic GVHD (cGVHD).

Study design: Retrospective cohort study of allo-HCT recipients with cutaneous GVHD treated with phototherapy at Memorial Sloan Kettering Cancer Center from 2009-2024. Patients received either narrow-band UVB or UVA1 and were followed for response to phototherapy based on NIH scoring criteria, body surface area involvement, and physician notes.

Results: Forty-six patients were evaluated, including 25 (54%) with aGVHD and 21 (46%) with cGVHD. Most patients received narrow-band UVB (94%). For aGVHD, complete response (CR) occurred in 48% and partial response (PR) in 44%, with an overall response rate (ORR) of 92%. For patients with cGVHD, CR occurred in 43% and PR in 48%, with an ORR of 91%. Median time to best response was 48 days for acute GVHD and 42 days for chronic GVHD. Systemic treatments, including corticosteroids and ruxolitinib, were commonly tapered during phototherapy. Adverse events occurred in 22% of patients, most commonly burning, with 9% discontinuing due to toxicity. Four patients developed skin cancer during follow-up, however three patients had a prior history of nonmelanoma skin cancer, and the remaining patient received concurrent extracorporeal photopheresis leading up to the diagnosis of melanoma in-situ.

Conclusions: Phototherapy is an effective and well-tolerated treatment for cutaneous GVHD, achieving high response rates and facilitating tapering of systemic immunosuppression. Given its favorable safety profile and rapid time to response, phototherapy should be considered as an adjunctive or steroid-sparing option for cutaneous GVHD, particularly in patients with extensive or treatment-refractory disease.