Successful Treatment of Chronic Sclerotic-Type Graft-Versus-Host Disease Localized to Areas of Breast Irradiation After Breast Cancer: A Report of Two Cases

Chronic sclerotic-type graft-versus-host disease (csGVHD) is a rare yet severe complication of allogeneic stem-cell transplant (allo-SCT), characterized by localized fibrosis and inflammation. This condition can manifest in areas of prior skin injury, including sites of therapeutic radiation, posing significant diagnostic and therapeutic challenges. Here, we report two unique cases of csGVHD confined to prior breast cancer radiation sites in women who underwent allo-SCT for hematologic malignancies. Both cases were managed with a multimodal therapeutic approach involving topical and intralesional corticosteroids, systemic immunosuppression, and phototherapy, resulting in symptom resolution and improved skin pliability. In this article, we discuss these cases and summarize the literature related to instances of localized csGVHD linked to radiation, exploring elements of the isoradiotopic phenomenon and radiation-induced injury treatment outcomes of immune mediated disease.