title: Extracorporeal photopheresis versus anticytokine therapy as a second-line treatment for steroid-refractory acute GVHD: a multicenter comparative analysis.
abstract: The optimal therapy for steroid-refractory (SR) acute graft-versus-host disease (aGVHD) is undefined. We studied patients with SR aGVHD, comparing extracorporeal photopheresis (ECP; n = 57) and anticytokine therapy (n = 41). In multivariate analyses, ECP, adjusted for steroid dose (odds ratio, 3.42; P = .007), and grade >II aGVHD (odds ratio, 68; P < .001) were independent predictors of response. ECP therapy, adjusted for conditioning regimen intensity and steroid dose, was associated with superior survival (hazard ratio [HR], 4.6; P = .016) in patients with SR grade II aGVHD. Grade >II aGVHD at onset of salvage therapy (HR, 9.4; P < .001) and lack of response to therapy (HR, 3.09; P = .011) were associated with inferior survival. These findings require validation in a prospective randomized study.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. madan.jagasia@vanderbilt.edu
authors.forename: Madan
authors.initials: M
authors.lastname: Jagasia
authors.forename: Hildegard
authors.initials: H
authors.lastname: Greinix
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.forename: Emma
authors.initials: E
authors.lastname: Das-Gupta
authors.forename: Ryan
authors.initials: R
authors.lastname: Jacobs
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.forename: Brian G
authors.initials: BG
authors.lastname: Engelhardt
authors.forename: Adetola
authors.initials: A
authors.lastname: Kassim
authors.forename: Nina
authors.initials: N
authors.lastname: Worel
authors.forename: Robert
authors.initials: R
authors.lastname: Knobler
authors.forename: Nigel
authors.initials: N
authors.lastname: Russell
authors.forename: Gerard
authors.initials: G
authors.lastname: Socie
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000037:antagonists & inhibitors* / Q000276:immunology; D004334:Drug Administration Schedule; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017893:Photopheresis; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000970:Antineoplastic Agents; D016207:Cytokines