Abstract
Purpose
There are limited treatment options available for hematopoietic stem-cell transplant patients (HSCT) with oral graft-versus-host disease (GVHD). Intraoral phototherapy is a novel, yet promising therapeutic regimen.Research question
To assess the safety and effectiveness of intraoral narrowband UVB (nbUVB) phototherapy in the treatment of oral GVHD.Methods
This case series evaluated 10 patients with refractory oral GVHD, who were treated at Northwestern Memorial Hospital with nbUVB between July 2019 and October 2023. Primary outcomes were to evaluate the safety and efficacy of phototherapy. Efficacy was measured by objective improvement in symptom scores and subjective improvement in patient reported symptoms. Safety was determined by the withdrawal due to adverse events. Total nbUVB exposure, number of treatments, and change in systemic immunosuppressive medications were also examined.Results
The study cohort comprised 10 patients who developed oral GVHD at a median of 9.5 months after HSCT. The total median dose of nbUVB was 36 J/cm2, and the median number of sessions was 55. All 10 patients demonstrated some degree of improvement in symptoms. Notably, there was a reduction in the number of patients who reported symptoms of oral pain (83%), bleeding (67%), xerostomia (50%), and oral sensitivity (78%) after initiating phototherapy. There was also a statistically significant decrease in the levels of pain, erythema, and edema (p ≤ 0.001, < 0.001, 0.01, respectively). Most patients tolerated phototherapy well, but 1 patient withdrew from treatment due to adverse effects. Seventy-five percent of patients who were on immunosuppressive medications were able to decrease or stop these medications.Conclusion
This case series suggests that nbUVB phototherapy is well tolerated and efficacious in patients with oral GVHD.References
Articles referenced by this article (10)
Intraoral psoralen ultraviolet A irradiation (PUVA) treatment of refractory oral chronic graft-versus-host disease following allogeneic stem cell transplantation.
Bone Marrow Transplant, (8):807-808 2001
MED: 11781637
Narrow-band UVB phototherapy for management of oral chronic graft-versus-host disease.
Photodermatol Photoimmunol Photomed, (2):75-82 2014
MED: 25229419
Oral PUVA and topical steroids for treatment of oral manifestations of chronic graft-vs.-host disease.
Photodermatol Photoimmunol Photomed, (4):184-190 2004
MED: 15238096
Treatment of oral chronic graft-versus-host disease with PUVA therapy: case report and literature review.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, (2):183-187 1998
MED: 9720094
PUVA therapy for drug-resistant graft-versus-host disease.
Bone Marrow Transplant, (2):227-236 1986
MED: 3502781
Ultraviolet B irradiation: a new therapeutic concept for the management of oral manifestations of graft-versus-host disease.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, (4):444-450 1999
MED: 10519752
Oral symptom intensity, health-related quality of life, and correlative salivary cytokines in adult survivors of hematopoietic stem cell transplantation with oral chronic graft-versus-host disease.
Biol Blood Marrow Transplant, (7):948-956 2010
MED: 20139026
Evaluation for Skin Cancer and Precancer in Patients With Vitiligo Treated With Long-term Narrowband UV-B Phototherapy.
JAMA Dermatol, (5):529-537 2020
MED: 32159729
UVB phototherapy and skin cancer risk: a review of the literature.
Int J Dermatol, (5):355-360 2005
MED: 15869531
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Review