title: Extracorporeal photochemotherapy in graft-versus-host disease: a longitudinal study on factors influencing the response and survival in pediatric patients.
abstract: BACKGROUND
  Extracorporeal photochemotherapy (ECP) is a valid therapeutic option in the treatment of acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively). No standard clinical and laboratory criteria of response to ECP treatment are available at the moment.
  
  
  METHODS
  Clinical and laboratory variables on 73 pediatric patients with aGVHD (n = 50) and cGVHD (n = 23) were correlated with response to ECP and survival.
  
  
  RESULTS
  An overall response (OR) was obtained in 34 of 50 (68%) aGVHD and in 16 of 23 (69.5%) cGVHD patients. Steroid tapering within 30 days of 1.3 mg/kg in OR (p = 0.004) was the sole highly significant correlation with response found in aGVHD while no correlation emerged for cGVHD (p = 0.28). Among aGVHD patients, response to ECP was inversely associated with death: among OR, deaths were 13 of 34 (38.2%), while among nonresponders, deaths were 15 of 16 (93.8%; p < 0.001). On the other hand, decrease of steroid dose at 30 days was associated with survival: for each 1 mg/kg reduction, the hazard ratio was 2.2, and the 95% confidence interval was 1.5 to 3.2 (p < 0.001). No other clinical or laboratory variables statistically associated with survival were found.
  
  
  CONCLUSIONS
  Our results demonstrate that steroid tapering within the first 30 days of ECP treatment in aGVHD and response to ECP in acute and chronic GVHD are the only variables influencing response and survival, respectively.
authors.affiliation: Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy. c.perotti@smatteo.pv.it
authors.forename: Cesare
authors.initials: C
authors.lastname: Perotti
authors.forename: Claudia
authors.initials: C
authors.lastname: Del Fante
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.forename: Gianluca
authors.initials: G
authors.lastname: Viarengo
authors.forename: Luigia
authors.initials: L
authors.lastname: Scudeller
authors.forename: Marco
authors.initials: M
authors.lastname: Zecca
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Laura
authors.initials: L
authors.lastname: Salvaneschi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008730:Methoxsalen / Q000008:administration & dosage*; D017893:Photopheresis; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013256:Steroids / Q000008:administration & dosage*; D015996:Survival Rate; D014184:Transplantation, Homologous
chemical_list: D017319:Photosensitizing Agents; D013256:Steroids; D008730:Methoxsalen