title: [Extracorporeal photopheresis in treatment of chronic graft versus host disease].
abstract: Extracorporeal photopheresis (ECP) is an immunomodulatory therapy which has been used in the treatment of chronic GVHD (cGVHD). ECP involves separation of the mononuclear cells with leukapheresis, followed by ex vivo administration of 8-methoxypsoralen and UV-A radiation and reinfusion to the patient. Aim of the study was to evaluate clinical and immunomodulatory effect of ECP procedures in patients with cGVHD. We analyzed 341 ECP procedures performed in 7 patients with cGVHD; median ECP per patient was 37 (range 13-131). All patients suffered from skin changes in combination with impaired joint mobility and symptoms of oral disease. ECP procedures were performed for two consecutive days: in initial phase weekly, followed by every two weeks and than monthly according to clinical response. Median of ECP treatment duration was 10 months (range 2-58). The effect of ECP in patients with cGVHD with skin andjoint involvement was mostly beneficial: 6 patients experienced either improvement or stabilization in skin changes and joint mobility. In 2 patients who suffered from oral disease, the total recovery was observed. Clinical response was typically delayed until 2 to 3 months, and reduction in glucocorticoid dose was observed. Adverse reactions were observed in 4.9% procedures. In patients who responded to ECP treatment, CD4+/CD8+ ratio and number of NK cells were normalized. ECP proved to be an efficient and safe procedure that may be recommended for patients with cGVHD who do not respond to conventional therapy.
authors.affiliation: Klinirki zavod za transfuzijsku medicinu i transplantacijsku biologiju, KBC Zagreb. ines.bojanic@kbc-zagreb.hr
authors.forename: Ines
authors.initials: I
authors.lastname: Bojanić
authors.forename: Ranka Serventi
authors.initials: RS
authors.lastname: Seiwerth
authors.forename: Sanja
authors.initials: S
authors.lastname: Mazić
authors.forename: Klara
authors.initials: K
authors.lastname: Dubravcić
authors.forename: Drago
authors.initials: D
authors.lastname: Batinić
authors.forename: Branka Golubic
authors.initials: BG
authors.lastname: Cepulić
authors.forename: Boris
authors.initials: B
authors.lastname: Labar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016516:CD4-CD8 Ratio; D002648:Child; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007592:Joint Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017893:Photopheresis / Q000009:adverse effects / Q000379:methods*; D012871:Skin Diseases / Q000209:etiology; D055815:Young Adult