Extracorporeal photoimmunotherapy for the treatment of steroid refractory progressive chronic graft-versus-host disease.
BACKGROUND
Chronic graft-versus-host disease (cGVHD) can arise frequently as a late complication after allogeneic hematopoietic cell transplantation. Patients with extensive disease to date require intensive and long-term immuno-suppression. We aimed to share our single center experience using extracorporeal photoimmunotherapy (ECP) in our steroid refractory extensive cGVHD patients.


METHODS
Eight patients with a median age 42 (range, 17-43) and M/F: 2/6 were treated with ECP (UVAR XTS) on 2 consecutive days every 2-4 weeks until resolution of GVHD over a period of 6-15 months concomitantly with immunosuppressive agents. Beyond extensive steroid refractory cutaneous cGVHD, three patients had also bronchiolitis obliterans (BO). Skin scores were assessed by an experienced dermatologist. Clinical, laboratory and radiological findings after 4 months of ECP were accepted as response criteria. The patients received in this almost fully automated system mean 261.4 ml buffy-coat was processed within 193 min using UVADEX sterile solution.


RESULTS
After a median of 12 cycles of treatment, 6 patients showed a favorable response. ECP was tolerated well only one patient developed Gr4 thrombocytopenia and another patient had a massive GIS bleeding due to an esophageal tear. Reduction in cholestatic parameters was observed in patients with liver cGVHD, improvement in respiratory functions and CT evaluations in two, and reduction in immunosuppressive requirement in all patients. The most impressive result was the reduced need for hospitalization of these patients and improvement of skin lesions. All but one of the skin biopsy scores was also better after ECP.


CONCLUSIONS
As extensive cGVHD is a life devastating disorder, every attempt to improve the quality of life should be evaluated carefully. Our findings suggest that ECP is a safe and effective adjunctive therapy for steroid refractory extensive cGVHD of the skin. ECP will find a place both for the treatment and may be for the prevention of GVHD as well.
Ilhan
Osman
O
Ankara University, Faculty of Medicine, Ibni Sina Hospital, Department of Hematology, Hemapheresis Unit and Blood Bank, Sihhiye 06100, Ankara, Turkey. oilhan@superonline.com
Arat
Mutlu
M
Arslan
Onder
O
Ayyildiz
Erol
E
Sanli
Hatice
H
Beksac
Meral
M
Ozcan
Muhit
M
Gürman
Günhan
G
Akan
Hamdi
H
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D004351:Drug Resistance; D005260:Female; D006086:Graft vs Host Disease / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007167:Immunotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017893:Photopheresis / Q000379:methods*; D012074:Remission Induction; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D013256:Steroids