Supplementary Material for: Photochemotherapy of Cutaneous Graft-versus-Host Disease May Reduce Concomitant Visceral Disease Feldreich N. Ringden O. Emtestam L. Omazic B. 10.6084/m9.figshare.3491615.v1 https://karger.figshare.com/articles/dataset/Supplementary_Material_for_Photochemotherapy_of_Cutaneous_Graft-versus-Host_Disease_May_Reduce_Concomitant_Visceral_Disease/3491615 <p><i>Background:</i> Photochemotherapy may be used to treat cutaneous graft-versus-host disease (GvHD). Animal models show that in the days after photochemotherapy and antigen provocation, cells with an antigen-specific suppressive phenotype are elicited in the lymphoid organs. In GvHD, host antigens are present not only in the skin treated by photochemotherapy but also in the visceral tissues. <i>Objective:</i> The aim of this paper was to evaluate the effect on visceral acute GvHD (aGvHD) of photochemotherapy of the skin. <i>Methods:</i> We retrospectively evaluated 33 patients with aGvHD of the skin, the liver, and/or the gastrointestinal tract treated with photochemotherapy for their aGvHD of the skin and did a long-term follow-up of 10 years on survival. <i>Results:</i> The complete response (CR) to photochemotherapy was 39%, the complete and partial response was 64% and the 6-month survival was 64%. Total body irradiation (TBI) before hematopoietic stem cell transplantation predisposed for CR of aGvHD of the liver and the gastrointestinal tract (p = 0.045). In the TBI group, the accumulated dose (numbers of treatments) for CR of visceral aGvHD increased with the body surface area affected by disease, from 8 (min-max: 5-14) for skin disease stage 1 to 10.5 (6-33) for stage 2 and 13 (11-21) for stage 3 (p = 0.04). Skin disease stage 1 showed a trend to be associated with CR in visceral disease at 28, 56, and 100 days (p = 0.07). Overall CR in visceral disease predicted a better 10-year overall survival (p = 0.0036). Finally, after TBI aGvHD of the gastrointestinal tract without anti-thymocyte globulin (ATG), clearance of T cells and dendritic cells responded better than aGvHD of the liver and aGvHD of the gastrointestinal tract with ATG (p = 0.01). <i>Conclusion:</i> Photochemotherapy after ionizing irradiation regulates the cell-mediated immunity in the viscera, and the systemic efficacy increases when the skin itself is less affected by disease. ATG modulates the regulatory effect of the gastrointestinal tract.</p> 2016-07-19 12:56:56 Photochemotherapy 8-methoxypsoralen Psoralen Furanocoumarin UVA PUVA GVHD aGvHD Total body irradiation Ionizing radiation HSCT Allogeneic stem cell transplantation