USE OF PHOTOPHERESIS THERAPY IN THE MANAGEMENT OF CHRONIC GRAFT-VERSUS-HOST DISEASE OF THE SKIN AND LIVER: CASE REPORT FROM A SPECIALIZED CENTER

Graft-versus-host disease (GVHD) is a serious immunological complication that may arise following allogeneic hematopoietic stem cell transplantation. GVHD is characterized by an immune response of the graft against the recipient's tissues and primarily affects the skin, liver, and gastrointestinal tract. Chronic GVHD presents with varied, long-term clinical manifestations that require specialized management and are often refractory to conventional immunosuppressive therapies. Therapeutic photopheresis has emerged as an effective, well-tolerated, and immunomodulatory alternative, especially for patients with significant skin and liver involvement. A 55-year-old white male with a history of a related allogeneic bone marrow transplant on July 1, 2016, developed chronic GVHD with skin and liver involvement. He experienced severe clinical manifestations, including malnutrition, xerostomia, xerophthalmia, erythema, intense pruritus, and generalized skin desquamation. Physical examination revealed dry, flaky skin with diffuse itching and dry mucous membranes, as well as impaired self-esteem; however, he maintained a good peripheral venous network. Laboratory tests showed elevated liver enzymes. His family history included skin cancer in his father, liver cancer in his mother, and chronic kidney disease in his brother, who is a kidney transplant patient. Due to clinical refractoriness and the limitations of conventional immunosuppressive therapies, Photopheresis Therapy was initiated in weekly sessions, totaling 48 sessions per year, adjusted according to clinical response. The intervention began in April 2022. Results: After six months of treatment, significant improvement in symptoms was observed, including regression of erythema, relief of pruritus, improvement of xerostomia and xerophthalmia, and progressive recovery of nutritional status. The patient continues to undergo weekly therapeutic photopheresis and is tolerating the treatment well with no relevant complications or adverse events. This case report reinforces the efficacy and safety of photopheresis therapy in managing chronic graft-versus-host disease with cutaneous and hepatic involvement. The significant improvement in clinical symptoms, absence of adverse effects, and good tolerability of the treatment highlight photopheresis therapy as a promising alternative for patients who do not respond to conventional therapies. This clinical experience contributes to evidence-based practice and emphasizes the importance of individualized approaches at specialized centers for patients undergoing bone marrow transplantation.