title: [Extracorporeal photopheresis in the treatment of patients with refractory chronic graft-versus-host disease after allogeneic bone marrow transplantation].
abstract: OBJECTIVE
  To evaluate the efficiency of extracorporeal photopheresis (ECP) in the treatment of patients with refractory chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).
  
  
  METHODS
  The study included 49 patients aged 2 to 55 years. Allo-HSCT was carried out in 38 (79%) patients with acute leukemias, 5 (10%) with chronic leukemias, 4 (8%) with myelodysplastic syndrome/myeloproliferative disease, and 2 (3%) with other hematologic diseases. The patients included in the study had glucocorticosteroid (GCS)-refractory disseminated cGVHD or a history of severe complications from GCS therapy.
  
  
  RESULTS
  When evaluating the efficiency of therapy, its response was recorded in 37 (77%) cases; the best results were obtained in patients with hepatic (82%), mucosal (76%), and skin (74%) lesions. The mean severity according to the cGVHD Working Group, National Institutes of Health, and a platelet level of more than 100.10(9)/1 were defined as factors improving a therapy response. In the patients receiving ECP, the overall survival was 70%. The latter was higher in the group of patients who had responded to ECP therapy without involving the gastrointestinal tract in the cGVHD process and in those receiving a combination of ECP and other immunosuppressive drugs.
  
  
  CONCLUSIONS
  ECP is an effective treatment for patients with refractory cGVHD, it may be used in those with a history of severe complications from GCS therapy. ECP allows the dose of GCS to be reduced to the point of complete discontinuation.
authors.forename: T A
authors.initials: TA
authors.lastname: Bykova
authors.forename: A V
authors.initials: AV
authors.lastname: Kozlov
authors.forename: N V
authors.initials: NV
authors.lastname: Stancheva
authors.forename: E V
authors.initials: EV
authors.lastname: Semënova
authors.forename: I I
authors.initials: II
authors.lastname: Kulagina
authors.forename: S N
authors.initials: SN
authors.lastname: Bondarenko
authors.forename: V N
authors.initials: VN
authors.lastname: Vavilov
authors.forename: E V
authors.initials: EV
authors.lastname: Morozova
authors.forename: L S
authors.initials: LS
authors.lastname: Zubarovskaia
authors.forename: B V
authors.initials: BV
authors.lastname: Afanas'ev
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000209:etiology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D017893:Photopheresis / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult