Extracorporeal Photopheresis (ECP) As Part of Combined Effective Immunotherapy Treatment of Graft-Versus-Host Disease

• Published in: Blood 2012-11, Vol.120 (21), p.1953-1953
• Main Authors: Bykova, Tatyana, Kozlov, Andrey, Estrina, Maria, Stancheva, Natalia V, Semenova, Elena V, Zubarovskaya, Ludmila S, Afanasyev, Boris V, Zander, Axel R.
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V120.21.1953.1953

Abstract 1953 Graft-vs-host disease (GVHD) is a serious complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT) causing significant morbidity and transplant-associated mortality. Acute GVHD (aGVHD) has been observed in approximately 60% of HLA-identical sibling transplants and up to 80% of unrelated donor grafts. Chronic GVHD (cGVHD) occurs in 50–70% of patients and frequently requires long-term systemic immunosuppressive treatment. Corticosteroids are considered to be the gold standard of first-line therapy for GVHD. Patients not responding to steroids have a dismal prognosis, being at risk of lifethreatening infections and severe organ toxicities. Extracorporeal photopheresis (ECP) has objective activity in the treatment of both acute and chronic steroid-refractory GVHD patients. The study included 82 patients (pts) after allo-HSCT, 34 with aGVHD and 48 with cGVHD. The age was from 2 to 55 y.o. (median 22 y.o.). Treatment aGVHD included tacrolimus or cyclosporine A basic immunosuppressive therapy with steroids (2 mg/kg) as a first line ± MAB. ECP combined with first line or used as third line, after MAB. Therapy cGVHD also included steroids (1 mg/kg) as a first line, imatinib or MMF used as a second line. ECP combined with first or second line therapy. Group aGVHD included: unrelated-HSCT – 20 pts, related-HSCT – 7 pts, haplo-HSCT – 7 pts; grade of aGVHD: II – 16 pts, III – 6 pts, IV – 12 pts; organs involvement: skin – 31 pts, GIT – 14 pts, liver – 7 pts. Group cGVHD included: unrelated-HCT – 26 pts, related-HCT – 12 pts, haplo-HCT – 10 pts; steroid-depended forms – 26 pts, steroid-refractory – 12 pts, steroid-intolerance – 10 pts; severity of cGVHD: moderate cGVHD – 15 pts, severe cGVHD – 33 pts; organs involvement: skin – 44 pts, mucosa – 27 pts, GIT – 11 pts, liver – 9 pts, lungs – 10pts. Infection complications (IC): for aGVHD group – total frequency - 73%, n=25 (bacterial – 53%, n=18, reactivation CMV – 61%, n=21, invasive fungal infection – 29%, n=10), the most frequent – lung infection and urinary tract infection. For cGVHD group: total frequency – 73%, n=35 (bacterial – 60%, n=29, reactivation CMV – 41%, n=20, invasive fungal infection – 56%, n=20), the most frequent – invasive pulmonary aspergillosis. Response to therapy was observed in 23 pts (67%) with aGVHD and in 36 cases with cGVHD (75%). Factors affecting the achievement of response were severity of GVHD: II grade aGVHD vs III, IV – 93% vs 44%, (p=0,015); «modera