Higher response rates in patients with severe chronic skin graft-versus-host disease treated with extracorporeal photopheresis

Different forms of graft-versus-host disease (GVHD) remain a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). The prognosis for steroid-refractory chronic GVHD (cGVHD) remains poor. Our aim was to evaluate extracorporeal photopheresis (ECP) trea...

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Bibliographic Details
Published in:Central-European journal of immunology 2019-01, Vol.44 (1), p.84-91
Main Authors: Afram, Gabriel, Watz, Emma, Remberger, Mats, Nygell, Ulla Axdorph, Sundin, Mikael, Hägglund, Hans, Mattsson, Jonas, Uhlin, Michael
Format: Article
Language:English
Subjects:
Apheresis
cGVHD
Clinical Immunology
Corticosteroids
ECP
Graft versus host disease
Graft-versus-host reaction
Hematopoietic stem cells
Immunosuppressive agents
Medical prognosis
Medicin och hälsovetenskap
Morbidity
Mortality
Photodynamic therapy
Remission
Skin diseases
Stem cell transplantation
Transplants & implants
treatment
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Summary:Different forms of graft-versus-host disease (GVHD) remain a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). The prognosis for steroid-refractory chronic GVHD (cGVHD) remains poor. Our aim was to evaluate extracorporeal photopheresis (ECP) treatment in cGVHD patients with different organ involvement to detect subgroups of patients with the best response. Thirty-four patients who underwent HSCT and developed moderate (n = 7) or severe (n = 27) steroid-refractory or steroid-dependent cGVHD treated with ECP were included in the analysis. A matched cGVHD control patient group untreated with ECP was collected for comparison. Compared to the control group and the stable/progressive disease (SD/PD) patients, individuals with complete/partial remission have higher overall survival and lower transplant-related mortality. Furthermore, patients with complete and partial remission (CR/PR) had significantly higher levels of albumin and platelets after ECP treatment compared to patients with stable or progressive cGVHD (SD/PD). Corticosteroid treatment and other immunosuppressive agents could successfully be tapered in the CR/PR group compared to the SD/PD patients. In this study patients with skin cGVHD are those with the highest rate of CR/PR after ECP treatment. Our results suggest that ECP treatment is safe and effective for patients with predominantly skin, oral and liver cGVHD.
ISSN:1426-3912
1644-4124
1644-4124
DOI:10.5114/ceji.2018.75831