title: Extracorporeal photopheresis: a useful therapy for patients with steroid-refractory acute graft-versus-host disease but not for the prevention of the chronic form.
abstract: BACKGROUND
  Extracorporeal photopheresis (ECP) has been used successfully to treat severe steroid-refractory acute and chronic graft-versus-host disease (aGVHD, cGVHD) since the late 1990s.
  
  
  OBJECTIVE
  To evaluate retrospectively the efficacy and safety of ECP in patients with aGVHD. We also assessed whether ECP may play a role in the prevention of cGVHD.
  
  
  METHODS
  Nine consecutive patients with allografts with aGVHD grade II-III, as defined by consensus criteria, and refractory to steroids, were treated with ECP. ECP was started at a median interval of 46·3 days (range 10-70) from aGVHD onset. Patients were treated initially on two consecutive days (one cycle) at 1-week intervals until improvement and then every 2 weeks. Treatment was then tapered off individually. To evaluate statistical relationships with outcome after 30, 60 and 90 days of ECP, all clinical and historical variables of the patients before treatment were analysed.
  
  
  RESULTS
  All patients survived and responded within 90 days. The average aGVHD score was 1·72 at aGVHD onset, 2·44 when ECP was started and then gradually declined to 0·44 on day 90. At the same time, the average dose of methylprednisolone declined from 2·22 mg kg(-1) to 0·27 mg kg(-1) (day 90), while the average dose of ciclosporin declined from 2·46 mg kg(-1) to 0·77 mg kg(-1) (day 90). Six of nine patients showed a complete skin response after 90 days of treatment. All patients with liver and gastrointestinal tract involvement had complete responses after 90 days, apart from one patient. All our patients developed cGVHD, seven of nine while still on maintenance regimen (6-13 months after haematopoietic stem cell transplantation, HSCT) and the other two patients after suspension of ECP (6 and 9 months after HSCT).
  
  
  CONCLUSIONS
  ECP is effective in patients with mild to moderate steroid-refractory aGVHD (grade II-III). On the other hand, ECP did not prevent the development of cGVHD in our patients.
authors.affiliation: Section of Dermatology, University of Siena, Siena, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Rubegni
authors.forename: L
authors.initials: L
authors.lastname: Feci
authors.forename: S
authors.initials: S
authors.lastname: Poggiali
authors.forename: G
authors.initials: G
authors.lastname: Marotta
authors.forename: G
authors.initials: G
authors.lastname: D'Ascenzo
authors.forename: F
authors.initials: F
authors.lastname: Murdaca
authors.forename: M
authors.initials: M
authors.lastname: Fimiani
mesh_terms: D000208:Acute Disease; D000328:Adult; D064591:Allografts; D002908:Chronic Disease; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control / Q000628:therapy*; D006402:Hematologic Diseases / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D017893:Photopheresis / Q000379:methods*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D013256:Steroids / Q000627:therapeutic use*; D019172:Transplantation Conditioning / Q000379:methods
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D008775:Methylprednisolone