Extracorporeal photochemotherapy in graft-versus-host disease: a longitudinal study on factors influencing the response and survival in pediatric patients.
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.
Perotti
Cesare
C
Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy. c.perotti@smatteo.pv.it
Del Fante
Claudia
C
Tinelli
Carmine
C
Viarengo
Gianluca
G
Scudeller
Luigia
L
Zecca
Marco
M
Locatelli
Franco
F
Salvaneschi
Laura
L
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
D017319:Photosensitizing Agents; D013256:Steroids; D008730:Methoxsalen