Graft-versus-host disease (GVHD) is a major complication in allogeneic bone-marrow transplantation (BMT). It is characterized by cutaneous changes, togethers with gastrointestinal and liver dysfunction. It has been shown that epidermal GVHD can be suppressed by UVB radiation in rats [3], and Langerhans cells (LC) may play a role in cutaneous GVHD [10]. In the present work, we investigated the effect of UVB radiation on the clinical, histological, and immunopathological changes of the skin after allogeneic BMT in man.
Fourteen patients were studied (Table 1). Thirteen patients underwent BMT for leukemia and were conditioned by cyclophosphamide and total-body irradiation (12 Gy). One patient was transplanted for severe aplastic anemia and was conditioned with cyclophosphamide and thoracoabdominal irradiation. They all were HLA-identical to their donors. All patients received cyclosporin as GVHD prophylaxis. Immunodepletion with anti-T cell monoclonal antibodies [anticluster of differentiation (CD) 4, CD 5, CD 8] was performed in 6 patients; CD4, CD5, and CD8 correspond to OKT4, OKTll, and OKT8, respectively. Seven patients received methotrexate at days 1, 3, 6, and 11 after BMT.
Acute GVHD usually develops 10 to 40 days after BMT [4]. To assess whether UVB radiation prevents acute cutaneous GVHD or not, from the first day after grafting, a limited area of the back (25 x 25 cm) of the patients was exposed to 80% of the minimal erythemal dose 5 times a week for 4 consecutive weeks,