title: Extracorporeal photochemotherapy for the treatment of steroid-resistant chronic GVHD.
abstract: Chronic graft-versus-host disease (GVHD) is a major limitation of successful allogeneic hematopoietic stem cell transplantation (HSCT). Extracorporeal photochemotherapy (ECP) has been tested extensively in small cohorts of patients with chronic GVHD. In this study, we retrospectively evaluated 71 patients with severe chronic GVHD treated with ECP. Response rate was 61% (n = 43), and 14 patients had complete responses (CRs). The best responses were observed in skin, liver, oral mucosa, and eye. Factors affecting outcomes were assessed in the less heavily pretreated subgroup (n = 63). Thrombocytopenia was associated with a lower response rate (P = .04), and there was a trend toward a higher response rate in de novo chronic GVHD. At 6 months, a total of 27 (69%) of 39 patients who were alive continued to have a sustained response (CR 4 [10%] of 39, and partial response [PR] 23 [59%] of 39). The cumulative incidence of steroid discontinuation at 1 year was 22%. The overall survival since initiation of therapy was 53% at 1 year. Response to ECP and platelet count at initiation of therapy were the strongest predictors of nonrelapse mortality (NRM) on univariate analysis. Objective responses were observed in a substantial number of patients with both skin and visceral chronic GVHD failing corticosteroids and other immunosuppression.
authors.affiliation: Department of Blood and Marrow Transplantation, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 423, Houston, TX 77030, USA. dcouriel@mdanderson.org
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Couriel
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Rima
authors.initials: R
authors.lastname: Saliba
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Shpall
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: Beverly
authors.initials: B
authors.lastname: Rhodes
authors.forename: Veronica
authors.initials: V
authors.lastname: Smith
authors.forename: Issa
authors.initials: I
authors.lastname: Khouri
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hsu
authors.forename: Shubhra
authors.initials: S
authors.lastname: Ghosh
authors.forename: Joyce
authors.initials: J
authors.lastname: Neumann
authors.forename: Borje
authors.initials: B
authors.lastname: Andersson
authors.forename: Muzzafar
authors.initials: M
authors.lastname: Qazilbash
authors.forename: Sharon
authors.initials: S
authors.lastname: Hymes
authors.forename: Stella
authors.initials: S
authors.lastname: Kim
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.forename: Michele
authors.initials: M
authors.lastname: Donato
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000755:Anemia, Sickle Cell / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy; D001943:Breast Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018572:Disease-Free Survival; D004351:Drug Resistance / Q000187:drug effects; D005123:Eye / Q000473:pathology; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D008099:Liver / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology; D017893:Photopheresis / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000473:pathology; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D013256:Steroids