title: Extracorporeal photochemotherapy in the treatment of severe steroid-refractory acute graft-versus-host disease: a pilot study.
abstract: Extracorporeal exposure of peripheral blood mononuclear cells to the photosensitizing agent 8-methoxypsoralen and UV-A radiation has been shown to be effective in the treatment of selected diseases mediated by T cells, rejection after solid organ transplantation, and chronic graft-versus-host disease (GVHD). We present 21 patients with a median age of 38 years who developed steroid-refractory acute GVHD grades II to IV after stem cell grafting from sibling or unrelated donors and were referred to extracorporeal photochemotherapy (ECP). Three months after initiation of ECP 60% of patients achieved a complete resolution of GVHD manifestations. Complete responses were obtained in 100% of patients with grade II, 67% of patients with grade III, and 12% of patients with grade IV acute GVHD. Three months after start of ECP complete responses were achieved in 60% of patients with cutaneous, 67% with liver, and none with gut involvement. Adverse events observed during ECP included a decrease in peripheral blood cell counts in the early phase after stem cell transplantation (SCT). Currently, 57% of patients are alive at a median observation time of 25 months after SCT. Probability of survival at 4 years after SCT is 91% in patients with complete response to ECP compared to 11% in patients not responding completely. Our findings suggest that ECP is an effective adjunct therapy for acute steroid-refractory GVHD with cutaneous and liver involvement. However, in patients with acute GVHD grade IV or gut involvement other therapeutic options are warranted.
authors.affiliation: Department of Medicine I, Bone Marrow Transplantation Unit, University of Vienna, Vienna, Austria. hildegard.greinix@akh-wien.ac.at
authors.forename: H T
authors.initials: HT
authors.lastname: Greinix
authors.forename: B
authors.initials: B
authors.lastname: Volc-Platzer
authors.forename: P
authors.initials: P
authors.lastname: Kalhs
authors.forename: G
authors.initials: G
authors.lastname: Fischer
authors.forename: A
authors.initials: A
authors.lastname: Rosenmayr
authors.forename: F
authors.initials: F
authors.lastname: Keil
authors.forename: H
authors.initials: H
authors.lastname: Hönigsmann
authors.forename: R M
authors.initials: RM
authors.lastname: Knobler
mesh_terms: D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D004351:Drug Resistance; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality; D006086:Graft vs Host Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007239:Infections / Q000209:etiology / Q000401:mortality; D008297:Male; D008730:Methoxsalen / Q000627:therapeutic use; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D017893:Photopheresis; D010865:Pilot Projects; D012867:Skin / Q000473:pathology; D012871:Skin Diseases / Q000209:etiology / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use; D015996:Survival Rate; D016896:Treatment Outcome; D014466:Ultraviolet Rays
chemical_list: D013256:Steroids; D008730:Methoxsalen