[Complete response of musculoskeletal chronic GVHD achieved with extracorporeal photopheresis therapy]

A 48-year-old man with acute myeloid leukemia underwent HLA-matched related donor peripheral blood stem cell transplantation. He developed chronic graft-versus-host disease (cGVHD) of the liver on day 359, which became dependent on cyclosporine and prednisolone. Long-term administration of cyclosporine led to progressive renal dysfunction. Ibrutinib was started, but was stopped due to acute cardiac failure. Mycophenolate mofetil was then started and liver cGVHD improved. The patient developed bacterial pneumonia and COVID-19 during this period. He began to experience limited range of motion in the shoulder joints beyond 2 years after transplantation, and suffered from progressive symptoms. To prevent additional infections due to myelosuppression, drug-induced liver dysfunction, and progression of renal dysfunction, extracorporeal photopheresis (ECP) was chosen to treat musculoskeletal cGVHD. ECP was started on day 1202 and completed 6 months later following the recommended schedule, without severe adverse events. Shoulder joint symptoms completely resolved with ECP, and the cGVHD score in joints decreased from 2 to 0. ECP is considered a promising treatment option for cGVHD patients who are at risk of infection and liver or renal dysfunction.