More than skin deep? Emerging therapies for chronic cutaneous GVHD

• Published in: Bone marrow transplantation (Basingstoke) Vol. 48; no. 3; pp. 323 - 337
• Main Authors: Rodgers, C J, Burge, S, Scarisbrick, J, Peniket, A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2013; Nature Publishing Group
• Subjects: 631/250/1904; 631/532/1542; 692/699/249/1529; 692/700/565; Algorithms; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Benzamides - administration & dosage; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Cell Biology; Cells (biology); Chronic Disease; Development and progression; Graft versus host reaction; Graft vs Host Disease - therapy; Hematology; Hematopoietic stem cells; Humans; Imatinib Mesylate; Internal Medicine; Lymphocytes B; Medical sciences; Medicine; Medicine & Public Health; Pathogenesis; Piperazines - administration & dosage; Progenitor cells; Public Health; Pyrimidines - administration & dosage; review; Reviews; Rituximab; Skin diseases; Skin Diseases - therapy; Stem cell transplantation; Stem Cells; Steroid hormones; Steroids; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Ultraviolet Therapy - methods; chronic cutaneous GVHD; imatinib; rituximab; Antineoplastic agent; Immunopathology; Graft versus host disease; Imatinib; Hematology; Enzyme; Tyrosine kinase inhibitor; Transferases; Stem cell; Enzyme inhibitor; Hematopoietic cell; Rituximab; Monoclonal antibody; Immunomodulator; Chronic; Treatment; Immunotherapy; Skin; Immunosuppressive agent; Protein-tyrosine kinase
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2012.96

The options for treating skin disease after haemopoietic progenitor cell transplant (HPCT) have broadened considerably over the last decade to include much more than topical steroids and emollients. This article reviews current and emerging therapies for chronic cutaneous GVHD, a well-recognised complication of HPCT. Alongside skin-directed therapies, there is now a wide range of systemic agents with differing targets for which an evidence base is emerging. Of particular interest, we summarise the role of electrocorporeal photopheresis, a therapy increasingly used in the United Kingdom to treat severe sclerodermoid manifestations of GVHD. We include a discussion of the expanding knowledge of the pathogenesis of cutaneous GVHD, which is informing our understanding and development of second line therapies (for example, the role of B cells and the utility of rituximab). Additionally, we draw attention to challenges encountered in the evaluation of chronic GVHD treatments and highlight recommendations for further research that may enable haematologists and dermatologists to provide better care for these patients. Finally, we present a clinical algorithm to aid the approach to treating limited and extensive disease and steroid refractory or persistent disease where steroid sparing may be necessary.