Extracorporeal chemophototherapy for the treatment of graft-versus-host disease: hematologic consequences of short-term, intensive courses.
OBJECTIVE
Extracorporeal chemophototherapy (ECP) is considered an immunomodulatory agent useful in both acute and chronic graft-versus-host disease (GVHD). Little is known about the best treatment schedule, and there are no data concerning hematologic parameters and cellular compositions of products during the treatment.


METHODS
This was a single-center study of 27 patients treated with ECP for corticoresistant GVHD. Treatment was given in a short-term series of six courses over 3 weeks, and in case of response, consolidation treatment was given until complete response or stabilization of lesions.


RESULTS
Nine out of 12 patients with acute GVHD responded to treatment. In patients with chronic GVHD, 13 out of 15 patients responded (11 complete and 2 partial responses). Responses were obtained essentially in skin or gut lesions; ECP was of particular effect in three cases of bronchiolitis obliterans associated with transplantation, with all three patients responding. Hematologic consequences were studied in patients with chronic GVHD: hemoglobin levels increased significantly after treatment and a reduction in red blood cell transfusion requirements was also observed.


CONCLUSIONS
ECP is effective in both chronic and acute GVHD, particularly in lung forms. ECP can reduce the duration of immunosuppressive therapy and improve erythroid recovery. ECP product quality, including standardization for the number of mononuclear cells for each patient, needs further investigation.
Garban
Frédéric
F
Département de Cancérologie et d'Hématologie, CHU de Grenoble BP217, 38043 Grenoble, France. frederic.garban@ujf-grenoble.fr
Drillat
Philippe
P
Makowski
Caroline
C
Jacob
Marie-Christine
MC
Richard
Marie-Jeanne
MJ
Favrot
Marie
M
Sotto
Jean Jacques
JJ
Bensa
Jean Claude
JC
Cahn
Jean Yves
JY
D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D002066:Busulfan / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000401:mortality; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007938:Leukemia / Q000145:classification / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D007166:Immunosuppressive Agents; D002066:Busulfan