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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Allogeneic haematopoietic stem cell transplantation &#40;allo-HCT&#41; is the treatment of choice and the only curative strategy in multiple malignant and non-malignant haematological pathologies&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It consists of the complete replacement of the patient&#39;s haematopoiesis&#44; because it is insufficient or neoplastic&#44; with haematopoietic progenitor cells from a compatible healthy donor&#44; after conditioning the patient with chemotherapy and&#47;or radiotherapy&#46; Its efficacy is based on the beneficial effect of the donor&#39;s lymphocytes&#44; responsible for the graft-versus-tumour effect &#40;GvT&#41;&#44; in which the donor&#39;s T cells act against the host&#39;s malignant cells&#44; providing a curative potential in haematopathies in which it is not possible to achieve a cure with the chemotherapy or pharmacological treatment available&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Graft-versus-host disease &#40;GvHD&#41; is one of the major undesirable complications of allo-HCT&#44; correlating with increased mortality&#44; second malignancies and a negative impact on quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Current mainstream research aims to minimise the risk of GvHD by maintaining GvT&#46; Chronic GvHD &#40;c-GvHD&#41; has a variable incidence depending on risk factors &#40;30&#37;&#8211;70&#37;&#41; and is the most frequent late complication&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> The median onset of cGvHD is 6 months after allo-HCT and usually occurs within 3 years after transplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Clinical manifestations are very diverse&#59; symptoms are characteristic of allo&#47;autoimmune disease with evidence of chronic inflammation and fibrosis of varying intensity&#46; About 50&#37; of patients will have multi-organ involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The skin is the most frequently affected organ&#44; but other tissues &#40;oral&#44; ocular and genital mucosa&#44; liver&#44; lungs&#44; gastrointestinal tract&#41; as well as joints and fascia are commonly involved&#46; Organ involvement may be simultaneous or successive&#44; with a major impact on the patient&#39;s quality of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Due to sustained immunosuppression&#44; frequent infections occur&#44; compromising patient survival&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the biggest challenges in the management of cGvHD is the establishment of a correct&#44; early diagnosis&#46; Recognising these difficulties&#44; the National Institutes of Health &#40;NIH&#41; promoted the formation of an international consensus group on cGvHD that proposed guidelines for correct clinical and pathological diagnosis&#44; unified response criteria and made recommendations for supportive care&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> with two subsequent updates&#44; the latest in 2020&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> This NIH consensus includes fasciitis and&#47;or joint contractures as definitive diagnostic criteria for cGvHD &#40;not requiring additional tests&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Reduced joint range of motion is usually secondary to sclerodermiform changes and&#47;or fasciitis&#44; as inflammatory joint involvement has rarely been observed&#46; A correct diagnostic approach to cGvHD requires establishing the diagnosis&#44; scoring the severity of each affected organ and classifying cGvHD as mild&#44; moderate or severe&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Different scales have been proposed to assess fascia and joint involvement&#58; the NIH Joint and Fascia Score 0&#8211;3 is a composite index that assesses joint stiffness&#44; range of motion &#40;ROM&#41; and activities of daily living &#40;ADL&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The Hopkins fascial scale uses a 0&#8211;3-point scale&#44; but only scores stiffness&#46; The photographic range of motion &#40;P-ROM&#41; scale is a series of images that captures ROM separately for shoulders&#44; elbows&#44; wrists&#47;fingers and ankles&#59; lower scores indicate more limited ROM&#46; The total P-ROM score is the sum of the scores at all 4 joints&#44; with a maximum possible score of 25 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The use of the P-ROM scale has been a breakthrough in terms of simplicity and objectivity&#59; it is also useful in detecting longitudinal changes by measuring response to treatment&#46; The NIH scale more accurately captures improvement&#44; while the P-ROM scale better captures worsening&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The skin is the most frequently affected organ&#44; and is often the initial manifestation of cGvHD&#46; Generalised scleroderma can lead to joint contractures and severe functional limitation&#44; frequently affecting the hands&#44; wrists&#44; shoulders&#44; elbows and ankles&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> Fasciitis due to inflammation of the fascia with an eosinophilic component may manifest as stiffness&#44; oedema&#44; arthralgia&#44; reduced motion and occasionally synovitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Because of the multisystemic nature of cGvHD&#44; its monitoring and treatment require a multidisciplinary approach&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Depending on its severity&#44; comorbidities and the risk of relapse of the patient&#39;s underlying disease&#44; the first line of treatment in moderate&#47;severe cases is corticosteroids&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Two out of three patients will not respond adequately and sustainably to this treatment and will require rescue therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objectives</span><p id="par0035" class="elsevierStylePara elsevierViewall">To conduct a systematic review of the literature on musculoskeletal &#40;fascial&#47;articular&#41; involvement as a manifestation of chronic graft-versus-host disease sclerotic phenotype in patients undergoing allogeneic haematopoietic stem cell transplantation&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To describe the clinical features&#44; diagnostic tools and therapeutic possibilities at present&#44; due to the absence of review publications on this topic&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material and methods</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data sources and search strategy</span><p id="par0045" class="elsevierStylePara elsevierViewall">A literature search was conducted in PubMed&#44; Embase and Cochrane&#44; using MeSH terms and keywords to select articles with information on chronic graft-versus-host disease and diagnostic musculoskeletal &#40;fascial&#44; joint&#41; involvement&#44; clinical characterisation&#44; methods of diagnostic evaluation and treatments &#40;see search strategy in Appendix Banexo 1 of the supplementary material&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Selection criteria</span><p id="par0050" class="elsevierStylePara elsevierViewall">As this is a poorly known topic from a rheumatological point of view&#44; a comprehensive search of the existing literature was conducted&#46; Studies from the last 20 years were included&#46; Priority was given to cross-sectional studies to evaluate diagnostic methods and clinical trials for articles on treatment&#46; For clinical manifestations&#44; case series and prospective or retrospective studies were considered&#46; Articles unrelated to the search were excluded &#40;avascular necrosis&#44; bone loss&#44; post-transplant joint infections&#44; Sj&#246;gren&#39;s syndrome and other systemic autoimmune diseases&#44; osteoporosis&#44; osteonecrosis&#44; osteomyelitis&#44; dermatological involvement only&#44; no allogeneic transplantation&#41;&#44; as were exclusively experimental&#47;preclinical studies&#44; in languages other than English or Spanish&#44; those that only included a paediatric population&#44; and those that referred exclusively to acute GvHD &#40;aGvHD&#41;&#46; We excluded muscle involvement &#40;myositis&#41; because it is not a diagnostic criterion for cGvHD and because of the existence of a recent systematic review on this condition&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Inclusion criteria were&#58; original studies &#40;clinical trials&#44; systematic reviews&#44; case-controls&#44; prospective or retrospective cohorts&#44; case series&#44; single cases&#41;&#44; allo-HCT recipients&#44; and the relationship of musculoskeletal manifestations to cGvHD&#46; Reviewing the references of the most relevant articles&#44; additional publications of interest were identified&#46; Articles were imported into the Zotero reference manager and duplicate articles were removed&#46; All abstracts were read by CHC and MDSG and full articles were obtained for review&#46; Where there were discrepancies they were agreed with the other authors &#40;LLC and JML&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> details the flowchart for article selection&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data extraction</span><p id="par0060" class="elsevierStylePara elsevierViewall">We classified the articles according to the musculoskeletal involvement to which they referred &#40;fasciitis&#44; arthropathy&#41; and according to the subject of the publication &#40;clinical&#44; diagnosis or treatment&#41;&#46; We extracted demographic data&#44; post-transplant time of the clinic&#44; differential characteristics&#44; treatment and other results on the different techniques of interest&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">We identified 6423 studies&#44; of which we reviewed 126 in depth&#44; to finally select 86&#58; 37 on clinical and diagnostic evaluation &#40;28 on fasciitis&#44; of which 23 refer to clinical manifestations cl&#237;nicas<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;14&#44;17&#8211;19&#44;24&#8211;42</span></a> and 5 to diagnosis&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;43&#8211;46</span></a> and 9 on arthropathy&#44; of which 6 on clinical symptoms<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7&#44;47&#8211;51</span></a> and 3 on diagnosis<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;43&#8211;46</span></a> and 49 on treatments administered &#40;7 on fasciitis fasciitis&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;12&#44;52&#8211;56</span></a> 9 on arthropathies<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16&#44;57&#8211;63</span></a> and 33 on therapies administered in sclerodermiform cGvHD with fascial and&#47;or joint involvement<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">64&#8211;96</span></a>&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Appendix Banexo 2 &#40;additional material&#41; contains all the articles analysed&#44; with the data extracted&#46; Appendix Banexo 3 &#40;additional material&#41; contains a glossary of terms and the colour code associated with each musculoskeletal manifestation for better understanding&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Most of the articles are of low quality&#44; including only isolated clinical cases or case series with a small and uncontrolled sample size &#40;36 articles&#44; approximately 41&#37;&#41;&#46; There are also 14 reviews &#40;&#8776;16&#37; reviews or consensuses&#41;&#44; 14 &#40;&#8776;16&#37;&#41; retrospective observational studies&#44; 11 &#40;&#8776;12&#37;&#41; prospective and only 7 &#40;8&#37;&#41; phase II trials&#46; We found only 3 systematic reviews&#58; 3 related to treatments &#40;UVA&#44;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">87</span></a> rituximab<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a> and extracorporeal photopheresis &#91;ECP&#93;&#41;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a> and a recently published comprehensive narrative review on cGvHD-related eosinophilic fasciitis &#40;EF&#41; by CHC and CLL&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">There is a need to identify early signs&#44; symptoms or other diagnostic determinants of cGvHD which are consistently associated with subsequent progression to highly morbid forms of cGvHD cGvHD&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Early detection of cGvHD requires careful and repeated assessments&#44; including physical examinations by experienced transplant specialists&#44; starting before transplantation and continuing through subsequent follow-up&#44; to allow formal diagnosis and assessment of the disease trajectory&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">97</span></a> Patient education is important for active participation in the detection of early signs and symptoms&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Fasciitis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Although skin changes are frequent&#44; the detection of fasciitis is not as common and its diagnosis is more difficult&#44; as physical signs and laboratory findings are not always present&#46; Fasciitis is the most relevant musculoskeletal manifestation of cGvHD&#44; with a reported annual incidence of &#46;5&#37;&#8211;47&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;31&#44;41&#44;42</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">48&#44;54</span></a> It is important to distinguish fasciitis from sclerodermiform cGvHD&#44; although the two can coexist in up to 80&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;48</span></a> Oedema is often the first sign of fascial involvement&#46; Fasciitis lesions are usually located in the proximal areas of the extremities and abdomen&#44; sparing the hands and feet&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;52</span></a> EF-like in the context of cGvHD looks like pseudocellulitis due to subcutaneous septal and fascial fibrosis&#44; often presenting with skin induration&#44; with typical &#8220;orange peel&#8221; or rippling appearance&#44; arthromyalgia&#44; peripheral eosinophilia and development of joint contractures in the most severe cases &#40;prayer sign&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A careful patient history and systematic physical examination&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> is very important&#44; as advanced fasciitis is hardly distinguishable from cutaneous sclerotic cGvHD&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> and the gradation of severity should be noted on collection sheets &#40;Appendix Banexo 4&#44; in additional material&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">When examining the patient&#44; progression from easily compressible mobile skin to &#8220;non-mobile&#8221; and &#8220;stone-like&#8221; tightness due to diffuse thickening suggests chronic fibrosis that is difficult to reverse&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> Range of motion should be assessed &#40;ideally with P-ROM&#41; in all patients at baseline and at subsequent check-ups&#44; which will allow us to grade severity and monitor response to treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;12&#44;13</span></a> Elastography measures<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;80</span></a> are promising&#44; although no large trials have been conducted to validate them&#46; In this regard&#44; most articles emphasize that the diagnosis of fasciitis should be established by histopathological findings - indistinguishable from those of classic EF - in the deep skin biopsy piel<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;25&#44;30&#44;33</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">41&#44;42</span></a> and by the alterations in the fascia seen in magnetic resonance imaging&#44;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;33&#44;34&#44;36</span></a> as a non-invasive test&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> that allows us to distinguish between exclusively cutaneous manifestations&#44; fasciitis and myositis&#44; also allowing us to locate the optimal area in which to perform the biopsy&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">On histopathological examination of fasciitis&#44; oedema and fibrosis are limited to the fasciae and subcutaneous septa&#44; with subcutaneous fat trapping and a pericapillary cellular lymphoplasmacytic infiltrate&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The natural history of fasciitis in cGvHD is often progressive&#44; leading to significant impairment of the patient&#39;s quality of life and functionality through stiffness&#44; joint contracture and reduced ROM&#44; as well as the development of chronic ulcers and scarring problems&#44; making early diagnosis and therapy with systemic immunosuppression crucial to prevent progression&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">CEF&#44; with a 55&#37;&#8211;85&#37; response&#44; or PUVA in addition to systemic immunosuppression&#44; can improve fascial involvement and prevent contractures&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">56&#44;70&#44;75</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Physiotherapy is the mainstay of supportive treatment of fasciitis&#44;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58&#44;63&#44;98</span></a> especially thermal modalities&#44; stretching&#44; joint mobilisation and lymphatic drainage&#44; and should be initiated as early as possible in order to prevent or resolve joint contractures&#46; Strengthening exercises are controversial&#44; as is surgical therapy of affected joints&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In addition&#44; caution should be exercised with physiotherapy or lymphatic drainage in the acute oedematous stage of fasciitis&#44; as inflammatory processes may be increased by mechanical irritation&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Response to treatment of fasciitis in GvHD is difficult to assess and has often been based on variable and subjective but practical criteria &#40;&#8220;complete response&#8221;&#44; &#8220;partial response&#8221;&#44; &#8220;no change&#8221;&#44; &#8220;progression&#8221;&#41;&#46; Scales of cutaneous or fascial involvement have been prospectively validated&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Arthropathy</span><p id="par0120" class="elsevierStylePara elsevierViewall">Fascia&#47;joint involvement is common in patients with cGvHD&#44; but the incidence of isolated joint involvement is low&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> sometimes unnoticed and under-diagnosed in early stages without a thorough examination of joint motion&#46; In advanced stages&#44; they cause sometimes irreversible joint contractures&#44; causing great disability and loss of quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The most frequently affected joints are the ankles &#40;93&#37;&#41;&#44; followed by the shoulders &#40;19&#37;&#41;&#44; wrists and fingers &#40;16&#37;&#41; and elbows &#40;9&#37;&#41;&#46; There is a high correlation of fascial&#47;articular sclerosis with skin involvement&#46; High levels of C3<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> have been reported&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Compared to patients with sclerotic skin changes&#44; patients with joint involvement appear to have less functional disability&#44; start earlier after diagnosis of cGvHD and have lower levels of inflammatory markers&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> Further studies are needed to determine whether joint involvement in the absence of skin changes represents deep tissue involvement below the clinical detection limit or a separate clinical process&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Ultrasound<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">99</span></a> and bone scintigraphy<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">100</span></a> have been used to diagnose joint involvement&#44; in addition to MRI and CT&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Synovitis related to cGvHD has also been found in the literature&#44; with the presence of donor cells in the synovial infiltration&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">98</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Physiotherapy and rehabilitation are essential - it is important that they are started early&#58; massage&#44; heat&#44; ultrasound&#44; paraffin&#44; stretching&#44; hydromassage&#44; strengthening and ADL training&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Pharmacological treatment</span><p id="par0145" class="elsevierStylePara elsevierViewall">In mild cGvHD&#44; topical treatment or systemic corticosteroids are used as monotherapy&#46; If fasciitis is present&#44; NSAIDs should be added&#46; In moderate cGvHD&#44; treatment is with a systemic IS &#40;usually prednisone with or without calcineurin inhibitors&#41; and topical treatment&#46; For severe cGvHD&#44; treatment would be the same as for moderate cGvHD&#44; with the addition of other IS&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">1st line treatment&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0155" class="elsevierStylePara elsevierViewall">Prednisone 1&#8239;mg&#47;kg&#47;day for 2&#8211;3 weeks&#44; then every other day for 2 weeks and then taper to 1&#8239;mg&#47;kg every 2 days for a period of 6&#8211;8 weeks if symptoms are stable or improve&#59; maintain this dose for 2&#8211;3 months or continue directly to taper by 10&#37;&#8211;20&#37; per month&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0160" class="elsevierStylePara elsevierViewall">Depending on severity&#44; it will be associated with calcineurin inhibitors &#40;cyclosporine A and tacrolimus&#41;&#46;</p></li></ul></p><p id="par0165" class="elsevierStylePara elsevierViewall">2nd line treatment&#58; There are no established protocols or standard treatment&#44; second-line or salvage treatments are prescribed from the numerous options available and are individually tailored &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">There is a need to identify biomarkers to predict treatment response&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> CD5&#43; B cells have been described as a biomarker of response to treatment with rituximab and nilotinib&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">72</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">We must also highlight the importance of supportive therapy for long-term patient care&#44; as more and more patients are receiving HCT and hosts are surviving longer&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and the value of multidisciplinary consultations for comprehensive patient care&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0180" class="elsevierStylePara elsevierViewall">Specific studies and reviews on musculoskeletal manifestations in cGvHD are limited and of low quality&#44; as we have reflected in the results&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">We have found that there is a need for systematic&#44; objective&#44; reliable and simple assessment of joint and fascial manifestations&#44; as early diagnosis and treatment are decisive in the patient&#39;s evolution&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">It is noteworthy that the NIH Consensus Fascia&#47;Joint score does not distinguish contributions to severity of cGvHD from isolated joint involvement compared to joint restriction associated with skin sclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">It is true that fascia&#47;joint involvement is common in cGvHD and the incidence of isolated joint contracture in the absence of skin sclerosis is low&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> but it is also likely to be under-diagnosed if a full range-of-motion examination is not routinely performed&#59; hence the importance of recording P-ROM at regular patient reviews&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;42</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Further studies are needed to determine whether joint involvement in the absence of sclerotic skin changes represents deep tissue involvement below the limit of clinical detection or whether it is a separate clinical process&#46; Future refinements of the NIH criteria may need to recognise joint restrictions that occur in the absence of sclerotic skin involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">The clinical&#44; genetic and biological factors specifically associated with musculoskeletal and joint involvement in patients with cGvHD are unknown&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">In these patients&#44; it is necessary to perform an analytical evaluation for peripheral eosinophilia as an early serological marker of cGvHD&#44; in particular fasciitis&#44; as well as the determination of muscle enzymes&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;29&#8211;31</span></a> The search for serum biomarkers in this fibrosing entity&#44; such as specific autoantibodies &#40;anti-sclerosis&#41; has so far been unsuccessful&#46; In a series of patients with eosinophilic-like fasciitis related to cGvHD&#44; positive antinuclear antibodies were detected in 25&#37; of patients&#44; with the nucleolar pattern being the most frequent&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Patients with clinical manifestations suggestive of EF-like cGvHD should undergo deep biopsy &#40;skin&#44; muscle and fascia&#41; and in some cases MRI to assess the extent of involvement and monitor response to treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;30</span></a> According to the NIH Consensus&#44; fasciitis is a &#8220;diagnostic&#8221; entity that does not require confirmation with additional tests&#44; but in the event of suggestive symptoms such as arthralgias&#44; muscle cramps&#44; joint stiffness or tendon rubbing&#44; imaging tests &#40;MRI&#44; high-frequency US&#41; 44&#44;80 and even diagnostic biopsy should be considered in certain isolated or doubtful cases&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Assessment of active joint motion as an objective measure with P-ROM is a very good option in routine practice&#44; together with the NIH joint&#47;fascia scale&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The NIH joint&#47;fascia score and the P-ROM total score should be used to assess therapeutic response in joint&#47;fascia c-GvHD&#46; A change from 0 to 1 in the NIH joint&#47;fascia score should not be considered as a worsening&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">In terms of treatment&#44; high-dose corticosteroids are still used as first line&#44; with their recognised adverse effects &#40;immunosuppression&#44; osteopenia&#44; avascular necrosis&#44; fractures&#44; muscle and skin atrophy&#44; oedema&#44; delayed healing&#8230;&#41; and in the case of cortico-refractoriness or intolerance to the first line&#44; there is no established standard treatment&#44; so the decision is based on the circumstances of each patient&#44; analysed on an individual basis&#46; Physiotherapy and other physical therapies have proven to be effective in improving functionality and preventing disease progression&#44; and should be started as early as possible&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">Musculoskeletal involvement related to c-GvHD is common and can cause significant functional impairment&#44; with great impact on quality of life&#46; Specific studies of fascial and joint complications are scarce and of low quality&#46; One of the major challenges in the management of c-GvHD is the establishment of a correct&#44; early diagnosis&#44; to improve the likelihood of response to treatment and the prevention of irreversible sequelae&#46; New biomarkers are needed to allow more targeted treatment in patients after first-line treatment failure&#46; Physiotherapy is essential to improve functionality and prevent disease progression and should be started early&#46; Because of the multisystemic nature of c-GvHD&#44; its monitoring and treatment require a multidisciplinary approach&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interests</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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            0 => "Enfermedad injerto contra receptor"
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            2 => "Contractura articular"
            3 => "Trasplante alog&#233;nico"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Chronic graft-versus-host disease &#40;cGVRD&#41; is a systemic immune-mediated complication that occurs in approximately half of the patients undergoing allogeneic haematopoietic stem cell transplantation &#40;allo-HCT&#41; and&#44; although it is associated with beneficial graft versus tumour effects and lower relapse rates&#44; it remains the leading cause of late morbidity and mortality in these patients&#46; The aim of this systematic review of the literature is to provide a current overview on the diagnostic musculoskeletal manifestations of cGVRD&#44; its clinical evaluation&#44; and therapeutic possibilities&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">We ran a systematic search in PubMed&#44; Embase&#44; and Cochrane Library&#46; Studies from the last 20 years were included&#46; Priority was given to cross-sectional studies to evaluate diagnostic methods and to clinical trials in the case of articles referring to treatment&#46; The search was limited to humans and articles published in English or Spanish&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">We identified 6423 studies&#44; of which we selected 86 &#40;37 on clinical and diagnostic evaluation and 49 on treatments&#41;&#46; Specific studies on fascial and joint complications are scarce and of low quality&#44; including only isolated clinical cases or case series&#46; Fasciitis is the most relevant musculoskeletal manifestation&#44; and isolated joint involvement is low&#44; sometimes unnoticed and underdiagnosed&#44; if a thorough exploration of joint motion is not performed&#46; Early detection of cGVRD with fascial and&#47;or joint involvement requires careful and repeated evaluation&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">The search for new biomarkers or advanced imaging techniques that allow early diagnosis is necessary&#46; Physiotherapy is essential to improve functionality and prevent disease progression&#46; Controlled studies are needed to establish recommendations on second lines of treatment&#46; Because of its multisystemic nature&#44; cGVRD requires a multidisciplinary approach&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">La enfermedad injerto contra receptor cr&#243;nica &#40;EICRc&#41; es una complicaci&#243;n inmunomediada sist&#233;mica que aparece en aproximadamente la mitad de los pacientes sometidos a trasplante alog&#233;nico de progenitores hematopoy&#233;ticos &#40;alo-HCT&#41; y&#44; aunque se asocia con efectos beneficiosos de injerto versus tumor y tasas de reca&#237;da m&#225;s bajas&#44; sigue siendo la principal causa de morbimortalidad tard&#237;a en estos pacientes&#46; El objetivo de esta revisi&#243;n sistem&#225;tica de la literatura es proporcionar una visi&#243;n actual sobre las manifestaciones musculoesquel&#233;ticas diagn&#243;sticas de EICRc&#44; su evaluaci&#243;n cl&#237;nica y sus posibilidades terap&#233;uticas&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda sistem&#225;tica en PubMed&#44; Embase y Cochrane Library&#46; Se incluyeron estudios de los &#250;ltimos 20 a&#241;os&#44; y se dio prioridad a los estudios transversales para evaluar m&#233;todos diagn&#243;sticos y a los ensayos cl&#237;nicos en el caso de art&#237;culos referidos a tratamiento&#46; La b&#250;squeda se limit&#243; a humanos y a art&#237;culos publicados en ingl&#233;s o espa&#241;ol&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Identificamos 6423 estudios&#44; de los cuales finalmente seleccionamos 86 &#40;37 sobre cl&#237;nica y evaluaci&#243;n diagn&#243;stica y 49 sobre tratamientos&#41;&#46; Los estudios espec&#237;ficos de complicaciones fasciales y articulares son escasos y de baja calidad&#44; al incluir &#250;nicamente casos cl&#237;nicos aislados o series de casos&#46; La detecci&#243;n temprana de la EICRc con afectaci&#243;n fascial y&#47;o articular requiere de evaluaciones cuidadosas y repetitivas&#44; incluidos ex&#225;menes f&#237;sicos por parte de especialistas con experiencia en trasplantes&#44; comenzando antes del trasplante y continuando a trav&#233;s del seguimiento posterior&#44; para permitir el diagn&#243;stico y la evaluaci&#243;n de la trayectoria de la enfermedad&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Es necesaria la b&#250;squeda de nuevos biomarcadores o de t&#233;cnicas de imagen avanzada que permitan realizar un diagn&#243;stico precoz&#46; La fisioterapia es esencial para mejorar la funcionalidad y prevenir la progresi&#243;n de la enfermedad&#46; Se precisan estudios controlados para establecer recomendaciones sobre las segundas l&#237;neas de tratamiento&#46; Por su car&#225;cter multisist&#233;mico&#44; la EICRc requiere un abordaje multidisciplinar&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
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        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0245" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0075"
          ]
        ]
      ]
    ]
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      0 => array:8 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photographic range of joint motion&#58; P-ROM scale&#46;</p>"
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      1 => array:8 [
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        "etiqueta" => "Fig&#46; 2"
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        "figura" => array:1 [
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of the selection of articles for inclusion and exclusion in the review&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">GvHD&#58; Graft-versus-host disease&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Source&#58; adapted from Andrews et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and Hamilton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Organ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagnosis &#40;sufficient to establish a diagnosis of cGvHD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distinctive &#40;observed in cGvHD&#44; insufficient alone to establish diagnosis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other characteristics or entities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muscle&#44; fascia&#44; joint&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fascitis&#44; joint contractures secondary to sclerosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Myositis or polymyositis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oedema&#44; muscle cramps&#44; arthralgia or arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagnostic and distinguishing criteria of chronic musculoskeletal GvHD&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">ADL&#58; activities of daily life&#59; NIH&#58; North American National Institutes of Health&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#58; Asymptomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58; Tightness in arms or legs&#44; normal or mildly impaired joint motion not affecting ADLs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#58; Tightness in arms or legs&#44; joint contractures&#44; erythema due to fasciitis&#44; moderately impaired joint motion with mild to moderate limitation of ADLs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#58; Contractures with severe impairment of joint motion severely affecting ADLs &#40;unable to tie shoes&#44; dress&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">NIH joint&#47;fascial scale&#46;</p>"
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Strength of evidence level&#58;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#8226; II&#58; &#62;1 well-designed clinical trial without randomisation&#44; cohort or case-control&#44; analytical &#40;preferably&#8239;&#62;&#8239;1 centre&#41; or multiple time series studies&#44; or dramatic results from uncontrolled experiments&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#8226; III&#58; opinions of respected authorities based on clinical experience&#44; descriptive studies or expert committee reports&#58;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>&#9702; III-1&#58; several reports of retrospective evaluations or small uncontrolled clinical trials&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>&#9702; III-2&#58; a report of a small uncontrolled clinical trial or retrospective evaluations&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>&#9702; III-3&#58; case reports&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Evidence&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">References&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Photopheresis&#44; UVA&#44; UVA 1&#44; UVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58&#44;61&#44;70&#44;75</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">79&#44;87&#44;90&#44;91</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">94&#44;96</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Calcineurin inhibitors &#40;cyclosporin A and tacrolimus&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;70</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mTOR inhibitors &#40;sirolimus&#44; everolimus&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tyrosine kinase inhibitors &#40;imatinib&#44; dasatinib&#44; bosutinib&#44; ruxolitinib&#44; nilotinib&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;55&#44;71&#44;72</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">77&#44;78&#44;81&#44;82</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">84&#44;86&#44;88&#44;91</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteosome inhibitors &#40;ixazomib&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IFN I inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">76</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">68&#44;74</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lidocaine iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;95</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rituximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">72&#44;77&#44;85&#44;89</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alemtuzumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alefacept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pentostatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CO<span class="elsevierStyleInf">2</span> Laser&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anti-TNF&#945; &#40;etanercept&#44; infliximab&#44; adalimumab&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methotrexate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vismodegib&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mesenchymal stem cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">66&#44;83&#44;93</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thoracoabdominal irradiation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Physiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58&#44;63&#44;98</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Topical silicone gel sheeting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">93</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Topical halofuginone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">91</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                      "doi" => "10.1158/0008-5472.CAN-16-1311"
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                    0 => array:2 [
                      "titulo" => "New ways to separate Graft-versus-Host disease and Graft-versus-Tumour effects after allogeneic haematopoietic stem cell transplantation"
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                      "doi" => "10.1111/bjh.12115"
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                        "tituloSerie" => "Br J Haematol&#46;"
                        "fecha" => "2013"
                        "volumen" => "160"
                        "paginaInicial" => "133"
                        "paginaFinal" => "145"
                        "link" => array:1 [ …1]
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "doi" => "10.1016/S0140-6736(09)60237-3"
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                        "link" => array:1 [ …1]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increasing incidence of chronic Graft-versus-Host disease in allogeneic transplantation&#58; a report from the center for International Blood and Marrow Transplant Research"
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            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How I conduct a comprehensive chronic graft-versus-host disease assessment"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood-2011-04-314815"
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                        "tituloSerie" => "Blood&#46;"
                        "fecha" => "2011"
                        "volumen" => "118"
                        "paginaInicial" => "2679"
                        "paginaFinal" => "2687"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The association of performance status and disease severity in patients with chronic Graft-vs-Host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.apmr.2018.04.034"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Phys Med Rehabil&#46;"
                        "fecha" => "2019"
                        "volumen" => "100"
                        "paginaInicial" => "606"
                        "paginaFinal" => "612"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disability associated with chronic Graft-versus-Host disease after allogeneic hematopoietic cell transplantation"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Blood&#46;"
                        "fecha" => "2021"
                        "volumen" => "138"
                        "paginaInicial" => "4060"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "German-Austrian-Swiss Consensus Conference on clinical practice in chronic graft-versus-host disease &#40;GVHD&#41;&#58; guidance for supportive therapy of chronic cutaneous and musculoskeletal GVHD"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2011.10573.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "2011"
                        "volumen" => "165"
                        "paginaInicial" => "18"
                        "paginaFinal" => "29"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National Institutes of Health Consensus Development Project on criteria for clinical trials in chronic graft-versus-host disease&#58; I&#46; Diagnosis and staging working group report"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2005.09.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2005"
                        "volumen" => "11"
                        "paginaInicial" => "945"
                        "paginaFinal" => "956"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease&#58; I&#46; The 2014 Diagnosis and Staging Working Group Report"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2014.12.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2015"
                        "volumen" => "21"
                        "paginaInicial" => "389"
                        "paginaFinal" => "401"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease&#58; IIb&#46; The 2020 Preemptive Therapy Working Group Report"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtct.2021.03.029"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transplant Cell Ther&#46;"
                        "fecha" => "2021"
                        "volumen" => "27"
                        "paginaInicial" => "632"
                        "paginaFinal" => "641"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of joint and fascia manifestations in chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Rheum&#46;"
                        "fecha" => "2014"
                        "volumen" => "66"
                        "paginaInicial" => "1044"
                        "paginaFinal" => "1052"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Strike a pose&#58; the role of photographic range of motion &#40;ROM&#41; images in detection&#44; monitoring&#44; and documentation of fasciitis and sclerosis associated with chronic graft-versus-host disease &#40;cGVHD&#41;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2018"
                        "volumen" => "24"
                        "paginaInicial" => "S451"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The anatomic distribution of skin involvement in patients with incident chronic graft versus host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2018.09.007"
                      "Revista" => array:2 [
                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2018"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ablative fractional laser resurfacing for treatment of sclerosis and contractures in chronic graft-versus-host disease&#58; a pilot study"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2019.07.084"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2020"
                        "volumen" => "82"
                        "paginaInicial" => "984"
                        "paginaFinal" => "986"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful treatment of refractory joint contractures caused by sclerodermatous graft versus host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bjps.2007.03.036"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Plast Reconstr Aesthet Surg&#46;"
                        "fecha" => "2008"
                        "volumen" => "61"
                        "paginaInicial" => "1235"
                        "paginaFinal" => "1238"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fasciitis after allogeneic peripheral blood stem cell transplantation in a patient with chronic myelogenous leukemia"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.RHU.0000037772.99917.86"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Rheumatol&#46;"
                        "fecha" => "2003"
                        "volumen" => "9"
                        "paginaInicial" => "33"
                        "paginaFinal" => "36"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fasciitis and myositis&#58; an analysis of muscle-related complications caused by chronic GVHD after allo-SCT"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/bmt.2008.297"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2009"
                        "volumen" => "43"
                        "paginaInicial" => "159"
                        "paginaFinal" => "167"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Joint and fascia manifestations in the course of graft-versus-host disease &#40;GVHD&#41; as a diagnostic trail for doctors of various specialties &#8211; case report"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.19271/IRONS-00054-2018-23"
                      "Revista" => array:5 [
                        "tituloSerie" => "Issue Rehabil Orthop Neurophysiol Sport Promot&#46;"
                        "fecha" => "2018"
                        "volumen" => "22"
                        "paginaInicial" => "55"
                        "paginaFinal" => "62"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus conference on clinical practice in chronic graft-versus-host disease &#40;GVHD&#41;&#58; first-line and topical treatment of chronic GVHD"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2010.06.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "1611"
                        "paginaFinal" => "1628"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus conference on clinical practice in chronic GVHD&#58; second-line treatment of chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2010.05.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "1"
                        "paginaFinal" => "17"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcome and prospective validation of NIH response criteria in 39 patients receiving imatinib for steroid-refractory chronic GVHD"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood-2013-05-494278"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood&#46;"
                        "fecha" => "2013"
                        "volumen" => "122"
                        "paginaInicial" => "4111"
                        "paginaFinal" => "4118"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic graft-versus-host disease presenting as acute polymyositis&#58; a case series and systematic review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.trim.2021.101520"
                      "Revista" => array:3 [
                        "tituloSerie" => "Transpl Immunol&#46;"
                        "fecha" => "2022"
                        "volumen" => "70"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Graft versus host disease-related eosinophilic fasciitis&#58; cohort descripci&#243;n and literature review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s42358-022-00262-3"
                      "Revista" => array:5 [
                        "tituloSerie" => "Adv Rheumatol&#46;"
                        "fecha" => "2022"
                        "volumen" => "62"
                        "paginaInicial" => "33"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eosinophilic fasciitis &#40;Shulman syndrome&#41;&#44; a rare entity and diagnostic challenge&#44; as a manifestation of severe chronic graft-versus-host disease&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13256-021-02735-3"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Med Case Rep&#46;"
                        "fecha" => "2021"
                        "volumen" => "15"
                        "paginaInicial" => "135"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Scleroderma mimics &#8211; clinical features and management"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Best Pract Res Clin Rheumatol&#46;"
                        "fecha" => "2020"
                        "volumen" => "34"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sclerodermalike syndromes&#58; great imitators"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2019.10.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol&#46;"
                        "fecha" => "2020"
                        "volumen" => "38"
                        "paginaInicial" => "235"
                        "paginaFinal" => "249"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous manifestations of scleroderma and scleroderma-like disorders&#58; a comprehensive review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12016-017-8625-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rev Allergy Immunol&#46;"
                        "fecha" => "2017"
                        "volumen" => "53"
                        "paginaInicial" => "306"
                        "paginaFinal" => "336"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute myofascitis as a manifestation of chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/mus.24937"
                      "Revista" => array:6 [
                        "tituloSerie" => "Muscle Nerve&#46;"
                        "fecha" => "2016"
                        "volumen" => "53"
                        "paginaInicial" => "327"
                        "paginaFinal" => "329"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eosinophilic fasciitis following allogeneic bone marrow transplantation in a patient with acute myeloid leukaemia"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2340/00015555-1669"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol&#46;"
                        "fecha" => "2014"
                        "volumen" => "94"
                        "paginaInicial" => "221"
                        "paginaFinal" => "222"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; risk factors&#44; and outcomes of sclerosis in patients with chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/blood-2012-10-464198"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood&#46;"
                        "fecha" => "2013"
                        "volumen" => "121"
                        "paginaInicial" => "5098"
                        "paginaFinal" => "5103"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Graft-versus-host disease of the skin and adjacent mucous membranes"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ddg.12103"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dtsch Dermatol Ges&#46;"
                        "fecha" => "2013"
                        "volumen" => "11"
                        "paginaInicial" => "477"
                        "paginaFinal" => "495"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extensive fasciitis as late manifestation of graft-versus-host disease&#44; a purpose of a case"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3324/haematol.2010.035675"
                      "Revista" => array:6 [
                        "tituloSerie" => "Haematologica&#46;"
                        "fecha" => "2011"
                        "volumen" => "96"
                        "paginaInicial" => "590"
                        "paginaFinal" => "591"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical fascial and muscular involvement in chronic GVHD after allo-SCT and radiation therapy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/bmt.2009.62"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2009"
                        "volumen" => "44"
                        "paginaInicial" => "451"
                        "paginaFinal" => "452"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Skin response using NIH consensus criteria vs Hopkins scale in a phase II study for steroid-refractory chronic GVHD"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/bmt.2009.84"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2009"
                        "volumen" => "44"
                        "paginaInicial" => "813"
                        "paginaFinal" => "819"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rippled skin&#44; fasciitis&#44; and joint contractures"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2008.08.023"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2008"
                        "volumen" => "59"
                        "paginaInicial" => "1070"
                        "paginaFinal" => "1074"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The clinical and histologic spectrum of chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2006.02.061"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2006"
                        "volumen" => "55"
                        "paginaInicial" => "729"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The changing face of graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.sder.2006.09.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Cutan Med Surg&#46;"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "190"
                        "paginaFinal" => "200"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eosinophilic fasciitis associated with autoimmune phenomena after bone marrow transplantation&#58; report of two cases"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-005-1138-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol&#46;"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "80"
                        "paginaFinal" => "82"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Muscle cramps and weakness secondary to graft versus host disease fasciitis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-1331.2004.00964.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Neurol&#46;"
                        "fecha" => "2005"
                        "volumen" => "12"
                        "paginaInicial" => "320"
                        "paginaFinal" => "322"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eosinophilic fasciitis after allogeneic stem cell transplantation&#58; a case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/10428190410001683787"
                      "Revista" => array:6 [
                        "tituloSerie" => "Leuk Lymphoma&#46;"
                        "fecha" => "2004"
                        "volumen" => "45"
                        "paginaInicial" => "1707"
                        "paginaFinal" => "1709"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fasciitis in chronic graft-versus-host disease&#46; A clinicopathologic study of 14 cases"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/0003-4819-120-12-199406150-00004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med&#46;"
                        "fecha" => "1994"
                        "volumen" => "120"
                        "paginaInicial" => "993"
                        "paginaFinal" => "998"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease&#58; IV&#46; The 2020 Highly morbid forms report"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtct.2021.06.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transplant Cell Ther&#46;"
                        "fecha" => "2021"
                        "volumen" => "27"
                        "paginaInicial" => "817"
                        "paginaFinal" => "835"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Magnetic resonance imaging in sclerotic-type chronic graft-vs-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archdermatol.2009.78"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol&#46;"
                        "fecha" => "2009"
                        "volumen" => "145"
                        "paginaInicial" => "918"
                        "paginaFinal" => "922"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histopathologic diagnosis of chronic graft-versus-host disease&#58; National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease&#58; II&#46; Pathology working group report"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2005.11.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2006"
                        "volumen" => "12"
                        "paginaInicial" => "31"
                        "paginaFinal" => "47"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute swelling of the limbs&#58; magnetic resonance pictorial review of fascial and muscle signal changes"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0720-048x(98)00119-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Radiol&#46;"
                        "fecha" => "1999"
                        "volumen" => "30"
                        "paginaInicial" => "11"
                        "paginaFinal" => "21"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pseudo-Volkmann contracture as a complication of chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Dermatol Ther&#46;"
                        "fecha" => "2021"
                        "volumen" => "34"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Joint and fascial chronic graft-vs-host disease&#58; correlations with clinical and laboratory parameters"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3325/cmj.2016.57.266"
                      "Revista" => array:6 [
                        "tituloSerie" => "Croat Med J&#46;"
                        "fecha" => "2016"
                        "volumen" => "57"
                        "paginaInicial" => "266"
                        "paginaFinal" => "275"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of isolated joint involvement in chronic graft-versus-host disease&#58; comment on the article by Inamoto et al&#46;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Rheum&#46;"
                        "fecha" => "2014"
                        "volumen" => "66"
                        "paginaInicial" => "2646"
                        "paginaFinal" => "2648"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The development of inflammatory arthritis and other rheumatic diseases following stem cell transplantation"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2008.03.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Arthritis Rheum&#46;"
                        "fecha" => "2009"
                        "volumen" => "39"
                        "paginaInicial" => "55"
                        "paginaFinal" => "60"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Late effects of chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.beha.2008.02.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Haematol&#46;"
                        "fecha" => "2008"
                        "volumen" => "21"
                        "paginaInicial" => "309"
                        "paginaFinal" => "331"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Refined National Institutes of Health response algorithm for chronic graft-versus-host disease in joints and fascia"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1182/bloodadvances.2019000918"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood Adv&#46;"
                        "fecha" => "2020"
                        "volumen" => "4"
                        "paginaInicial" => "40"
                        "paginaFinal" => "46"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rehabilitation in chronic Graft-versus-Host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pmr.2016.08.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Phys Med Rehabil Clin N Am&#46;"
                        "fecha" => "2017"
                        "volumen" => "28"
                        "paginaInicial" => "143"
                        "paginaFinal" => "151"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic graft-versus-host disease presenting as eosinophilic fasciitis&#58; therapeutic challenges and an additional case"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RHU.0000000000000212"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Rheumatol&#46;"
                        "fecha" => "2015"
                        "volumen" => "21"
                        "paginaInicial" => "86"
                        "paginaFinal" => "94"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imatinib is effective for prevention and improvement of fibrotic fasciitis as a manifestation of chronic GVHD"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/bmt.2011.10"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2012"
                        "volumen" => "47"
                        "paginaInicial" => "139"
                        "paginaFinal" => "140"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extracorporeal photochemotherapy for treatment of fasciitis in chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.bmt.1704436"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2004"
                        "volumen" => "33"
                        "paginaInicial" => "869"
                        "paginaFinal" => "870"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leflunomide for chronic musculoskeletal graft versus host disease following allogeneic hematopoietic stem cell transplant"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41409-019-0545-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2020"
                        "volumen" => "55"
                        "paginaInicial" => "467"
                        "paginaFinal" => "469"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful treatment of sclerotic cutaneous graft-versus-host disease using extracorporeal photopheresis"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JDDG J German Soc Dermatol&#46;"
                        "fecha" => "2020"
                        "volumen" => "18"
                        "paginaInicial" => "34"
                        "paginaFinal" => "38"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leflunomide&#58; is it the game changer in musculoskeletal chronic graft versus host disease&#63;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12288-018-0929-x"
                      "Revista" => array:2 [
                        "tituloSerie" => "Indian J Hematol Blood Transfus&#46;"
                        "fecha" => "2018"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "60"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Musculoskeletal&#44; neurologic&#44; and cardiopulmonary aspects of physical rehabilitation in patients with chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2014.10.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2015"
                        "volumen" => "21"
                        "paginaInicial" => "799"
                        "paginaFinal" => "808"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            60 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Extracorporeal photopheresis in treatment of chronic graft versus host disease&#93;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lijec Vjesn&#46;"
                        "fecha" => "2013"
                        "volumen" => "135"
                        "paginaInicial" => "139"
                        "paginaFinal" => "144"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            61 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tocilizumab for the treatment of steroid refractory graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2011.07.001"
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                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "1862"
                        "paginaFinal" => "1868"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Therapeutic experience on multiple contractures in sclerodermoid chronic graft versus host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00520-009-0602-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Support Care Cancer&#46;"
                        "fecha" => "2009"
                        "volumen" => "17"
                        "paginaInicial" => "851"
                        "paginaFinal" => "855"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hedgehog blockade in steroid-refractory sclerotic chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjh.17657"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Haematol&#46;"
                        "fecha" => "2021"
                        "volumen" => "195"
                        "paginaInicial" => "e120"
                        "paginaFinal" => "2"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rehabilitation interventions in the multidisciplinary management of patients with sclerotic Graft-versus-Host disease of the skin and fascia"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.apmr.2020.10.141"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Phys Med Rehabil&#46;"
                        "fecha" => "2021"
                        "volumen" => "102"
                        "paginaInicial" => "776"
                        "paginaFinal" => "788"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            65 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mesenchymal stem cells for scleroderma-like graft versus host disease&#58; a case series"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cytotherapy&#46;"
                        "fecha" => "2021"
                        "volumen" => "23"
                        "paginaInicial" => "24"
                      ]
                    ]
                  ]
                ]
              ]
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            66 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ixazomib for treatment of refractory chronic Graft-versus-Host disease&#58; a chronic GVHD Consortium Phase II trial"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2020.05.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2020"
                        "volumen" => "26"
                        "paginaInicial" => "1612"
                        "paginaFinal" => "1619"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            67 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complete remission of sclerodermatous cutaneous graft-versus-host disease after low-dose interleukine-2 treatment"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.16524"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol&#46;"
                        "fecha" => "2020"
                        "volumen" => "34"
                        "paginaInicial" => "e791"
                        "paginaFinal" => "3"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            68 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fractional CO&#40;2&#41; laser for the treatment of sclerodermatous cGVHD"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/14764172.2019.1710537"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Laser Ther&#46;"
                        "fecha" => "2020"
                        "volumen" => "22"
                        "paginaInicial" => "49"
                        "paginaFinal" => "51"
                        "link" => array:1 [ …1]
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                ]
              ]
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            69 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fototherapy in the resistant chronic cutaneous graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Dermatol Rev Mex&#46;"
                        "fecha" => "2020"
                        "volumen" => "64"
                        "paginaInicial" => "50"
                        "paginaFinal" => "57"
                      ]
                    ]
                  ]
                ]
              ]
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            70 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sclerodermatous chronic Graft-versus-Host disease treated with imatinib&#58; a dermatological perspective"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermo-Sifiliogr&#46;"
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                        "volumen" => "109"
                        "paginaInicial" => "241"
                        "paginaFinal" => "247"
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                ]
              ]
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            71 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective evaluation of sequential treatment of sclerotic chronic graft versus host disease with rituximab and nilotinib"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41409-018-0158-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2018"
                        "volumen" => "53"
                        "paginaInicial" => "1255"
                        "paginaFinal" => "1262"
                        "link" => array:1 [ …1]
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                    ]
                  ]
                ]
              ]
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            72 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reprint of&#58; emerging therapeutics for the control of chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2017.12.788"
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                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2018"
                        "volumen" => "24"
                        "paginaInicial" => "S7"
                        "paginaFinal" => "14"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            73 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "74"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and tolerance of ruxolitinib in refractory sclerodermatous chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.15593"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "177"
                        "paginaInicial" => "e206"
                        "paginaFinal" => "8"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            74 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "75"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Phototherapy for sclerosing skin conditions"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2016.05.012"
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                        "tituloSerie" => "Clin Dermatol&#46;"
                        "fecha" => "2016"
                        "volumen" => "34"
                        "paginaInicial" => "614"
                        "paginaFinal" => "622"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            75 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "76"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Type I IFNs regulate inflammation&#44; vasculopathy&#44; and fibrosis in chronic cutaneous Graft-versus-Host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4049/jimmunol.1502190"
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                        "tituloSerie" => "J Immunol&#46;"
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                        "volumen" => "197"
                        "paginaInicial" => "42"
                        "paginaFinal" => "50"
                        "link" => array:1 [ …1]
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            76 => array:3 [
              "identificador" => "bib0385"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized phase II crossover study of imatinib or rituximab for cutaneous sclerosis after hematopoietic cell transplantation"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Clin Cancer Res&#46;"
                        "fecha" => "2016"
                        "volumen" => "22"
                        "paginaInicial" => "319"
                        "paginaFinal" => "327"
                        "link" => array:1 [ …1]
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            77 => array:3 [
              "identificador" => "bib0390"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imatinib mesylate for the treatment of steroid-refractory sclerotic-type cutaneous chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
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                        "paginaInicial" => "1083"
                        "paginaFinal" => "1090"
                        "link" => array:1 [ …1]
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            78 => array:3 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Extracorporeal photopheresis for chronic graft-versus-host disease&#58; a systematic review and meta-analysis"
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                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Blood Res&#46;"
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                        "paginaInicial" => "100"
                        "paginaFinal" => "106"
                        "link" => array:1 [ …1]
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                ]
              ]
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            79 => array:3 [
              "identificador" => "bib0400"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "&#171;Assessment of chronic sclerodermoid Graft-versus-Host disease patients&#44; using 20 MHz high-frequency ultrasonography and cutometer methods&#187;"
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                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-0846.2012.00659.x"
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                        "tituloSerie" => "Skin Res Technol&#46;"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "e417"
                        "paginaFinal" => "422"
                        "link" => array:1 [ …1]
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                ]
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            80 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "81"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A case of sclerodermatous graft-versus-host disease responsive to imatinib therapy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1525-1470.2010.01301.x"
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                        "tituloSerie" => "Pediatr Dermatol&#46;"
                        "fecha" => "2011"
                        "volumen" => "28"
                        "paginaInicial" => "172"
                        "paginaFinal" => "175"
                        "link" => array:1 [ …1]
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                ]
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            81 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "82"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are tyrosine kinase inhibitors promising for the treatment of systemic sclerosis and other fibrotic diseases&#63;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Swiss Med Wkly&#46;"
                        "fecha" => "2010"
                        "volumen" => "140"
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                    ]
                  ]
                ]
              ]
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            82 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "83"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of bone marrow-derived mesenchymal stem cells in the treatment of sclerodermatous chronic graft-versus-host disease&#58; clinical report"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2009.11.006"
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                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
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                        "volumen" => "16"
                        "paginaInicial" => "403"
                        "paginaFinal" => "412"
                        "link" => array:1 [ …1]
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                    ]
                  ]
                ]
              ]
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            83 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "84"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tyrosine kinase inhibitors for the treatment of fibrotic diseases such as systemic sclerosis&#58; towards molecular targeted therapies"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2009.120196"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Rheum Dis&#46;"
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                        "numero" => "Suppl 1"
                        "paginaInicial" => "i48"
                        "paginaFinal" => "51"
                        "link" => array:1 [ …1]
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                ]
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            84 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "85"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of rituximab in the setting of Steroid-Refractory Chronic Graft-versus-Host disease&#58; a systematic review and meta-analysis"
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                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
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                        "paginaInicial" => "1005"
                        "paginaFinal" => "1013"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
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            85 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "86"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of imatinib mesylate in the treatment of refractory sclerodermatous chronic GVHD"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/bmt.2008.252"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2008"
                        "volumen" => "42"
                        "paginaInicial" => "757"
                        "paginaFinal" => "760"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            86 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "87"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultraviolet A phototherapy for sclerotic skin diseases&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2008.07.042"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2008"
                        "volumen" => "59"
                        "paginaInicial" => "1017"
                        "paginaFinal" => "1030"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            87 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "88"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imatinib as a potential treatment for sclerodermatous chronic graft-vs-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archderm.144.9.1106"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol&#46;"
                        "fecha" => "2008"
                        "volumen" => "144"
                        "paginaInicial" => "1106"
                        "paginaFinal" => "1109"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            88 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "89"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rituximab is effective for steroid-refractory sclerodermatous chronic graft-versus-host disease"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.leu.2403996"
                      "Revista" => array:6 [
                        "tituloSerie" => "Leukemia&#46;"
                        "fecha" => "2006"
                        "volumen" => "20"
                        "paginaInicial" => "172"
                        "paginaFinal" => "173"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            89 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "90"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medium dose long-wavelength ultraviolet A &#40;UVA1&#41; phototherapy for the treatment of acute and chronic graft-versus-host disease of the skin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.bmt.1704804"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2005"
                        "volumen" => "35"
                        "paginaInicial" => "515"
                        "paginaFinal" => "519"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            90 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "91"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Phototherapy and imatibib of sclerosing skin diseases"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-0781.2005.00154.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Photodermatol Photoimmunol Photomed&#46;"
                        "fecha" => "2005"
                        "volumen" => "21"
                        "paginaInicial" => "157"
                        "paginaFinal" => "165"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            91 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "92"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Silicone gel sheet dressing for sclerodermatous type chronic graft-versus-host-disease &#40;cGVHD&#41;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Turk J Haematol&#46;"
                        "fecha" => "2004"
                        "volumen" => "21"
                        "paginaInicial" => "107"
                        "paginaFinal" => "110"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            92 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "93"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Halofuginone to treat fibrosis in chronic graft-versus-host disease and scleroderma"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1083-8791(03)00151-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Blood Marrow Transplant&#46;"
                        "fecha" => "2003"
                        "volumen" => "9"
                        "paginaInicial" => "417"
                        "paginaFinal" => "425"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            93 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "94"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "UVA1 therapy for sclerodermic graft-versus-host disease of the skin"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mjd.2002.121352"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2002"
                        "volumen" => "46"
                        "paginaInicial" => "799"
                        "paginaFinal" => "800"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            94 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "95"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beneficial effect of intravenous lidocaine in cutaneous chronic graft-versus-host disease secondary to donor lymphocyte infusion"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.bmt.1703080"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2001"
                        "volumen" => "28"
                        "paginaInicial" => "97"
                        "paginaFinal" => "99"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            95 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "96"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic sclerodermic graft-versus-host disease refractory to immunosuppressive treatment responds to UVA1 phototherapy"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0190-9622(00)90023-9"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2000"
                        "volumen" => "42"
                        "numero" => "1 Pt 1"
                        "paginaInicial" => "134"
                        "paginaFinal" => "136"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            96 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "97"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease&#58; IIa&#46; The 2020 Clinical Implementation and Early Diagnosis Working Group Report"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtct.2021.03.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transplant Cell Ther&#46;"
                        "fecha" => "2021"
                        "volumen" => "27"
                        "paginaInicial" => "545"
                        "paginaFinal" => "557"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            97 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "98"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunohistochemical and FISH analyses identify synovitis associated with chronic GVHD after allogeneic hematopoietic SCT"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/bmt.2008.161"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bone Marrow Transplant&#46;"
                        "fecha" => "2008"
                        "volumen" => "42"
                        "paginaInicial" => "289"
                        "paginaFinal" => "291"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            98 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "99"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hf-usg and cutometer in monitoring of sclerodermoid cgvhd patients with joint contractures"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Skin Res Technol&#46;"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "e586"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            99 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "100"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bone scintigraphy pattern of joint chronic graft-versus-host disease after allogeneic bone marrow transplantation"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RLU.0b013e31818f4355"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Nucl Med&#46;"
                        "fecha" => "2009"
                        "volumen" => "34"
                        "paginaInicial" => "20"
                        "paginaFinal" => "23"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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