Tratamiento con PUVA en la enfermedad injerto contra huésped agudo

Introduction. Acute graft - vs - host disease (GvHD) is one of the principal mean complications of allogenic bone marrow transplantation (BMT). In non-responding patients with GvHD the first line of management, psoralen and ultraviolet A radiation (PUVA) can be used. Case report. A 9 years old girl with acute lymphoblastic leukemia, Philadelphia chromosome positive, received an allogenic - BMT from her HLA identical sister, and GvHD profilaxis with cyclosporine, and methotrexate. Engraftment occurred on day +12 and she presented grade II GvHD; on day +23 she presented reactivation and progression of the skin lesions which were treated with methylprednisolone 1 g/m 2 , cyclosporine, and methotrexate weekly; however, skin lesion progressed to epidermolysis. Psoralen 0.3 mg/kg in a single dose followed by ultraviolet A radiation (UVA) 0.3 J/cm 2 was started; UVA was increased 0.5 J/cm 2 in each exposition until a maximal dose of 8 J/cm 2 was reached. After 15 expositions with an accumulated dose of 57/96 J programmed the lesson recovered without secondary alterations. Conclusions. Although the precise mechanism of PUVA in GvHD is not clear it is a useful treatment, easy to apply, and with minimal secondary effects.