Successful extracorporeal photochemotherapy for chronic graft-versus-host disease in pediatric patients.
A total of 254 extracorporeal photochemotherapy (ECP) procedures were performed in 8 children (median age 10 years; range 5-15) with extensive resistant chronic graft-versus-host disease (GVHD). ECP was carried out in the pediatric environment using a Cobe Spectra separator and UV-MATIC irradiator. A peripheral venous with a single-lumen permanent central catheter access (69% of ECP-apheresis) or a dual-lumen permanent central catheter access (26% of ECP-apheresis) were used preferentially. A median platelet decrease of 17% (0-71) (p = 0.0001) and median hemoglobin level decrease of 15 g/L (0-31)(p = 0.0001) were noted following each ECP-apheresis. However, none of the patients had profound thrombocytopenia or anemia. Two minor episodes of catheter related-bacteriemia (Staphylococcus aureus) were noted (2310 catheter-days). A negative correlation was found between lymphocyte collection efficacy (median = 38%) and pre ECP-apheresis lymphocyte count (r = 0.4, p = 0.00001). The median of 5 x 10(7) lymphocytes/kg (0.1-50.10(7)/kg) was irradiated in each procedure. All patients are alive and well, and 7/8 experienced a dramatic improvement in their cutaneous status. Liver and gut disease resolved completely in 4/6 and 5/5 patients, respectively. In all patients, a concomitant immunosuppressive therapy was stopped (5/8) or considerably reduced (3/8). Five patients with more than 2 years follow-up after discontinuation of ECP are in remission with no immunosuppression treatment. They have normal growth rates and normal school and sport activity. Our study shows that ECP is beneficial, well tolerated, and can be safely used for chronic GVHD treatment even in young children with low body weight and a poor performance status. We believe that having a dedicated pediatric environment together with an experienced, motivated, and specifically pediatric team is of crucial importance for improving patient's acceptance of this long-term therapeutic program.
Unité Bioclinique de Thérapie Cellulaire, C.H.U. Clermont-Ferrand, France.
Pascale
P
Halle
Catherine
C
Paillard
Michel
M
D'Incan
Pierre
P
Bordigoni
Christophe
C
Piguet
Lionel
L
De Lumley
Jean Louis
JL
Stephan
Marc
M
Berger
Chantal
C
Rapatel
François
F
Deméocq
Justyna
J
Kanold
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D006086:Graft vs Host Disease / Q000191:economics / Q000628:therapy*; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D017893:Photopheresis / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D011446:Prospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome