Extracorporeal photopheresis in the treatment of chronic graft-versus-host disease. The Hellenic experience: a study by the Hellenic association of hematology.
The Hellenic experience regarding the efficacy of extracorporeal photopheresis (ECP) in the treatment of 58 patients with chronic graft-versus-host disease (cGVHD) is presented in this article. All 58, except one patient, had failed at least one line of immunosuppressive treatment including steroids. Thirty-three out of 58 patients showed an objective overall response to ECP in a median time of 10 weeks after the onset of treatment. The cumulative incidence of overall response was 65.1%. In multivariate analysis, the presence of severe chronic GVHD was the only parameter associated with a significantly lower probability of response to treatment (RR=0.4, CI 95% 0.2-0.9, p=0.03). Responders to treatment with ECP were more likely to discontinue immunosuppression, had a lower probability of non-relapse mortality (RR=0.2, CI 95% 0.1-0.5, p=0.002), and a higher probability of overall survival (RR=7.8, CI 95% 3-20, p<0.001) in comparison with non-responders. Eight out of 58 patients experienced relapse of the original disease. The cumulative incidence of relapse in the group of responders to ECP was 6%, while it was 25% in the group of non-responders to ECP. In multivariate analysis, response to treatment with ECP was the only parameter statistically associated with a significantly decreased hazard of relapse (RR=0.1, CI 95% 0.1-0.7, p=0.02). ECP should be tested as first-line treatment in patients with cGVHD with the aim to minimize the duration of immunosuppression and the rate of relapse of the malignant disease.
2nd Department of Internal Medicine, ATTIKON General University Hospital, Medical School, University of Athens, Greece. panagtsirigotis@gmail.com
Panagiotis
P
Tsirigotis
Panayotis
P
Kaloyannidis
Apostolia
A
Papalexandri
Ioannis
I
Baltadakis
Dimitrios
D
Karakasis
Ioannis
I
Batsis
Ioanna
I
Sakellari
Vassiliki
V
Kitra
Evgenios
E
Goussetis
Sotirios
S
Papageorgiou
Alexandros
A
Spyridonidis
Stelios
S
Graphakos
Nikolaos
N
Harhalakis
Ioannis
I
Dervenoulas
Achilles
A
Anagnostopoulos
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality* / Q000628:therapy*; D006405:Hematology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D017893:Photopheresis / Q000379:methods*; D012189:Retrospective Studies; D012955:Societies, Medical; D015996:Survival Rate