Analysis of clinical outcome and survival in pediatric patients undergoing extracorporeal photopheresis for the treatment of steroid-refractory GVHD.
Extracorporeal photopheresis (ECP) has been used for treatment of steroid-refractory graft-versus-host disease (GVHD) with encouraging results. However, only a few pediatric centers have experienced with ECP, mainly by technical difficulties of leukapheresis in children. We retrospectively analyzed 27 patients treated during 5 years with ECP for steroid-refractory acute and chronic GVHD. We performed an "off-line" approach using a continuous flow cell separator (Cobe Spectra) and a Ultraviolet A irradiator (UVAMATIC). Among acute GVHD patients, 11 of 21 obtained a complete remission (CR) and another 8 reached partial remission. In the chronic GVHD group, 3 patients obtained CR and another 2 were in partial remission. Disease-free survival probability was 43±9% in the whole group. The only variable that impacts on disease-free survival on multivariate analysis was achieving CR with ECP. We also found a better CD4/CD8 ratio after ECP. In detail, among CD4 lymphocyte population, an increase in the effector memory and T-regulatory population was found. We may conclude that ECP is a safe and effective steroid-refractory GVHD treatment using the ex-vivo collection method, even in small children. Clinical response favorably impacts on long-term survival and seems to be associated with peripheral blood lymphocyte subset changes generating peripheral tolerance.
Stem Cell Transplant Unit, Pediatric Hematology-Oncology Section, Hospital Niño Jesús, Madrid, Spain. mgonzalezv.hnjs@salud.madrid.org
Marta
M
González Vicent
Manuel
M
Ramirez
Julián
J
Sevilla
Lorea
L
Abad
Miguel Angel
MA
Díaz
D000208:Acute Disease; D000293:Adolescent; D016516:CD4-CD8 Ratio; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018572:Disease-Free Survival; D004351:Drug Resistance / Q000276:immunology; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D017893:Photopheresis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
D013256:Steroids