Extracorporeal photopheresis (ECP) improves overall survival in the treatment of steroid refractory acute graft-versus-host disease (SR aGvHD)

• Published in: Bone marrow transplantation (Basingstoke) 2023-02, Vol.58 (2), p.168-174
• Main Authors: Solh, Melhem M., Farnham, Chloe, Solomon, Scott R., Bashey, Asad, Morris, Lawrence E., Holland, H. Kent, Zhang, Xu
• Format: Article
• Language: English
• Subjects: 692/308/2171; 692/700/565/2319; Acute Disease; Apheresis; Cell Biology; Chronic Disease; Cytomegalovirus Infections - drug therapy; Graft versus host disease; Graft vs Host Disease; Graft-versus-host reaction; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Internal Medicine; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - drug therapy; Patients; Photodynamic therapy; Photopheresis - methods; Public Health; Retrospective Studies; Stem cell transplantation; Stem Cells; Steroids; Steroids - therapeutic use; Survival; Toxicity; Transplantation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-022-01860-x

Steroid refractory acute graft-versus-host disease (SR aGvHD) is a major limitation of successful allogeneic hematopoietic stem cell transplantation (HSCT). Extracorporeal photopheresis (ECP) has been used to treat SR aGvHD effectively and with low treatment related toxicity. In this study, we retrospectively analyzed the outcomes of 103 Steroid Refractory aGvHD (SR aGvHD) patients to identify factors associated with improved outcomes including the use of ECP. A total of 79 patients received ECP as part of their SR aGVHD treatment compared to 24 patients who did not. Both groups had similar aGVHD grade and maximum organ stage at onset of aGVHD and treatment initiation. Patients in the group that received ECP had better OS ( p  = 0.01), DFS ( p  = 0.008), lower relapse ( p  = 0.05) and similar NRM compared to the group that did not receive ECP. Patients that received ECP treatment also had shorter hospital stays in the first 180 days after onset of SR aGvHD (20 vs. 38 days, p  = 0.03). Multivariable analysis for OS indicated patient CMV status (CMV+ versus CMV–, HR 2.34, CI 1.16–4.69), regimen intensity (Myelo vs. non-Myeloablative, HR 0.39, CI 0.20–0.75), and the use of ECP (ECP vs. no ECP, HR 0.39, CI 0.20–0.75) were associated with OS. In summary, the use of ECP in the treatment of SR aGvHD results in improved overall survival secondary to lower relapse rates compared to other therapeutic modalities that do not incorporate ECP.