Low-Dose (One Gray) Total-Lymphoid Irradiation for Extensive, Drug-Resistant Chronic Graft-Versus-Host Disease

Chronic graft-versus-host disease (CGVHD),* a multisystemic syndrome that develops 80–400 days after allogenic marrow transplantation, affects 25–45% of long-term survivors (1, 2). With early medical treatment using prednisone with either azathioprine and/or cyclosporine, scleroderma and joint contractures now rarely occur. Nevertheless, a small proportion of patients will eventually develop dermal thickening, joint contractures, and sicca syndrome (3), which may be resistant to therapy with standard immunosuppressive agents (4).