I02 GVHD and extracorporeal photopheresis

✍ Scribed by H.T. Greinix

• Publisher: Elsevier Science
• Year: 2007
• Tongue: English
• Weight: 96 KB
• Volume: 21
• Category: Article
• ISSN: 0268-960X
• DOI: 10.1016/s0268-960x(07)70003-6

✦ Synopsis

Graft-versus-host disease (GVHD) is a major cause of mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Extracorporeal exposure of peripheral blood mononuclear cells to the photosensitizing agent 8-methoxypsoralen and ultraviolet A radiation has been shown to be effective in treatment of selected T-cell mediated diseases, including cutaneous T-cell lymphoma and rejection after organ transplantation. In a phase II study on patients with steroid-refractory acute GVHD grades II to IV given adjunct ECP as secondline therapy CR was achieved in 82% of patients with cutaneous involvement, 61% with liver involvement, and 61% with gut involvement. The probability of survival was 59% among patients who responded completely to ECP compared to 11% in patients not responding completely. Thus, intensified ECP was highly effective in acute GVHD and sustained responses are associated with over 50% long-term survival. Currently, a randomized controlled multicenter study of ECP is ongoing for the treatment of patients with newly diagnosed acute GVHD. ECP given in retrospective studies to heterogeneous patient populations is associated with high response rates in chronic extensive GVHD with skin, liver and oral involvement. In a recent multicenter, prospective, phase II study in steroidintolerant, steroid-dependent or steroid-refractory chronic GVHD patients, ECP was effective in skin manifestations and steroid-sparing could be demonstrated. ECP was well tolerated with a safety profile consistent with previous studies.