title: Efficacy of bimonthly extracorporeal photopheresis in refractory chronic mucocutaneous GVHD.
abstract: Extracorporeal photopheresis (ECP) has become a recognised treatment for steroid-refractory chronic GVHD (cGVHD), but the optimal frequency and duration of treatment are yet to be established. We report on 82 consecutive patients with mucocutaneous cGVHD who received a bimonthly regimen of ECP treatment for two consecutive days, which could be subsequently tapered to a monthly regimen depending on response. Patients were steroid-refractory, steroid-dependent or steroid-intolerant, and 29 (35%) had multiorgan involvement. The median duration of treatment was 330 days (42-987). The median number of ECP cycles was 15 (1.5-32). Response was assessed by clinical assessment and reduction in immunosuppression after 6 months. 69/82 (84%) had completed 6 months of ECP and 65/69 (94%) had ≥ 50% improvement in symptoms and signs of cGVHD. A total of 77% of patients who completed 6 months of ECP had a reduction in immunosuppression dose and 80% had decreased their steroid dose (27.5% stopped, 30% had ≥ 75% reduction, 17.5% had ≥ 50% reduction and 25% had <50% reduction). OS at 3 years from the start of ECP was 69%. This study reports the largest series of patients receiving bimonthly ECP treatment for cGVHD, and confirms that ECP allows successful reduction of immunosuppression.
authors.affiliation: St John's Institute of Dermatology, St Thomas' Hospital, London, UK. fldignan@doctors.org.uk
authors.forename: F L
authors.initials: FL
authors.lastname: Dignan
authors.forename: D
authors.initials: D
authors.lastname: Greenblatt
authors.forename: M
authors.initials: M
authors.lastname: Cox
authors.forename: J
authors.initials: J
authors.lastname: Cavenagh
authors.forename: H
authors.initials: H
authors.lastname: Oakervee
authors.forename: J F
authors.initials: JF
authors.lastname: Apperley
authors.forename: A K
authors.initials: AK
authors.lastname: Fielding
authors.forename: A
authors.initials: A
authors.lastname: Pagliuca
authors.forename: G
authors.initials: G
authors.lastname: Mufti
authors.forename: K
authors.initials: K
authors.lastname: Raj
authors.forename: D I
authors.initials: DI
authors.lastname: Marks
authors.forename: P
authors.initials: P
authors.lastname: Amrolia
authors.forename: A
authors.initials: A
authors.lastname: Peniket
authors.forename: P
authors.initials: P
authors.lastname: Medd
authors.forename: M N
authors.initials: MN
authors.lastname: Potter
authors.forename: B E
authors.initials: BE
authors.lastname: Shaw
authors.forename: J J
authors.initials: JJ
authors.lastname: Scarisbrick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000628:therapy*; D019337:Hematologic Neoplasms / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017893:Photopheresis / Q000379:methods*; D012871:Skin Diseases / Q000628:therapy*; D013997:Time Factors