The incidence of chronic graft-versus-host-disease is rising year by year which

The incidence of chronic graft-versus-host-disease is rising year by year which has become the leading cause of non-transplantation related death and has become the most difficult complication of allogeneic hematopoietic stem cell transplantation to deal with. may be a safe and effective method for chronic graft-versus-host-disease. Keywords: graft-versus-host disease hydrogen cytokines transplantation INTRODUCTION Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been widely used in many hematological diseases. Chronic graft-versus-host disease (cGVHD) is one of the most common complications of allo-HSCT which has become the leading cause of non-transplantation related death (Martin et al. 2010 With the increase application of allo-HSCT in elderly patients the wide application of peripheral blood stem cells as a graft and improvement of the early survival rate after transplantation the incidence of cGVHD is rising year by year (Anasetti et al. 2012 cGVHD is a kind of disease similar to systemic lupus erythematosus (SLE) and scleroderma (Lee et al. 2003 It is widely accepted that imbalance of inflammatory factors (such as tumor necrosis factor alpha (TNF-α) interleukin (IL)-2 IL-6 IL-10 IL-12 interferon (INF)-gamma transforming growth factor (TGF)-beta etc.) and fibrosis occupy the dominant position in the mechanism of cGVHD (Flowers and Martin 2015 In 2007 Ohsawa et al. (2007) discovered that hydrogen gas has antioxidant properties. Since then hydrogen gas has come to the forefront BIBR 1532 of therapeutic medical gas research. Recent basic and clinical research (Fukuda et al. 2007 Cai et al. 2008 Nagata et al. 2009 Sun et al. 2009 proved that hydrogen could down-regulate cytokines including chemokine (C-C motif) ligand 2 (CCL2) IL-1β IL-6 BIBR 1532 IL-12 TNF-α etc. In 2011 Terasaki et al. (2011) also demonstrated that hydrogen has anti-fibrosis effect. Since 2009 hydrogen was applied on the field of organ transplantation including intestinal transplantation lung transplantation renal transplantation and heart transplantation. It was demonstrated that hydrogen could protect allograft function in those models (Buchholz et al. 2008 Nakao et al. 2009 Cardinal et al. 2010 Kawamura et al. 2010 2011 Chuai et al. 2012 We also reported the therapeutic effects of hydrogen gas on acute graft-versus-host disease (Qian and Shen 2013 Qian et al. 2013 We reasoned that hydrogen may have therapeutic effects on cGVHD. BIBR 1532 CASE REPORT A 54-year-old Chinese man in our outpatient clinic was diagnosed with myelodysplastic syndromes French-American-British (FAB) subtype refractory anemia with excess blasts-2 (RAEB-2) based on bone marrow morphology and developed cGVHD 3 years after allo-HSCT. He was diagnosed to have cGVHD. Clinical characters are shown in Table 1 according to National Institutes of Health (NIH) standards (Jagasia et al. 2015 He was given treatment of prednisone and tacrolimus but the symptoms were not controlled. When he came to our outpatient clinic he was still treated with oral 10 mg prednisone daily and 0.5 mg tacrolimus. We added hydrogen-rich BIBR 1532 water (500 mL three times per day 0.6 mM) which CCNA2 was prepared as we previously described (Qian et al. 2013 Prednisone and tacrolimus were tapered in three months. After 3 and 6 months the patient’s clinic characters were evaluated again as shown in Table 1. The patient is still alive until this report with good life quality. Table 1 Clinical characters of the patient with chronic graft-versus-host disease treated by hydrogen rich water CONCLUSIONS The incidence of cGVHD is rising year by year and there is no ideal treatment cGVHD has become the most intractable complications after allo-HSCT which greatly reduces the patient’s life quality and survival rate. In the past three decades glucocorticoids (e.g. prednisone prednisolone dexamethasone) calcineurin inhibitors (e.g. tacrolimus cyclosporin) and other immunosuppressive agents still play critical roles in cGVHD. cGVHD is often with long course and side effects of these drugs are always too severe to be tolerated (Flowers and Martin 2015 Hydrogen however has few side effects making it able to be used safely for a long term. Further studies with large sample size are needed to verify whether hydrogen results in a significant improvement in patient outcomes..