title: Long-term extracorporeal photoimmunotherapy for treatment of chronic cutaneous graft-versus-host disease: observations in four patients.
abstract: BACKGROUND
  Chronic cutaneous graft-versus-host disease (GvHD) can arise as a late complication after allogeneic bone marrow transplantation. Patients with extensive disease to date require intensive early and long-term immunosuppression; however, treatment is often insufficient. Since the beneficial effects of phototherapy for chronic cutaneous GvHD are well known, extracorporeal photoimmunotherapy (ECP) was also tried with some success for a few single patients with this disease.
  
  
  OBJECTIVE
  The long-term effect of ECP was evaluated in 4 patients with therapy-resistant severe chronic cutaneous GvHD after allogeneic bone marrow transplantation.
  
  
  METHODS
  Four patients were treated with monthly sessions of ECP over a period of 16-40 months. Disease severity was assessed by a semiquantitative score adapted from the literature including extent of skin area involved, rigidity of the skin, involvement of joints and immunosuppressive drug consumption.
  
  
  RESULTS
  In all patients, a favorable response was observed after 6-12 treatment cycles. One patient had a complete response, 2 patients had a partial response, and 1 patient had a minor response after treatment. In 2 patients, immunosuppressive medication started before initiating ECP could be reduced or completely withdrawn under ECP. Peripheral blood lymphocyte immunophenotyping revealed reduction of CD3+ CD4+ T cells in 3 patients and of elevated CD3+ CD8+ and CD57+ CD8+ T cell subsets in 2 patients.
  
  
  CONCLUSIONS
  ECP is effective in treating severe chronic cutaneous GvHD. ECP possibly exerts its effects by reducing the number of CD8+ suppressor/cytotoxic T cells, the presumptive effector cells of GvHD. ECP is well tolerated with essentially no side effects and allows reducing the dosage of immunosuppressive agents.
authors.affiliation: Department of Dermatology, University Medical Center Benjamin Franklin, Free University of Berlin, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Dippel
authors.forename: S
authors.initials: S
authors.lastname: Goerdt
authors.forename: C E
authors.initials: CE
authors.lastname: Orfanos
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000628:therapy*; D006801:Humans; D016130:Immunophenotyping; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D010865:Pilot Projects; D012883:Skin Ulcer / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents