title: Steroid-sparing effect of extracorporeal photopheresis in the therapy of graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Steroid-refractory graft-versus-host disease (GVHD) remains a challenging therapeutic problem after allogeneic hematopoietic stem cell transplantation (HSCT). The aim of this study was to evaluate the clinical effect of extracorporeal photopheresis (ECP), and its impact on intensivity of immunosuppresive therapy in allogeneic HSCT patients.
  
  
  METHODS
  In this study 443 Therakos ECP procedures were performed in 21 patients after allogeneic HSCT with acute (aGVHD, 8 patients) or chronic (cGVHD, 13 patients) therapy-refractory GVHD. The median age at ECP onset was 20.5 years (range, 10-55). Venous access was provided by a nontunelized central venous catheter (12 patients) or 9.6-French portacath (9 patients).
  
  
  RESULTS
  In the cGVHD group 9/13 patients were improved with a 4-year overall survival rate of 67.7%. ECP led to steroid discontinuation in 6 and substantial dose reduction in 5 patients. The prednisone dose equivalent per kilogram body weight decreased from 0.32 mg to 0.07 mg after therapy. Therapy of aGVHD led to complete or partial symptom remission in 3/9 subjects. The change in steroid dose in the aGVHD group was not significant, there were no long-term survivors. Portacath access was well tolerated and provided adequate blood flow rates.
  
  
  CONCLUSIONS
  The ECP therapy significantly reduced the rates of remissions with steroid discontinuation among cGVHD but not aGVHD patients. Rare ECP-related complications were either catheter related or anticoagulation induced during ECP procedures. Photopheresis was a safe, effective method to treat steroid-resistant cGVHD.
authors.affiliation: Department of Pediatric Bone Marrow Transplantation, Hematology and Oncology, Wroclaw Medical University, Wroclaw, Poland. Electronic address: ussowicz@tlen.pl.
authors.forename: M
authors.initials: M
authors.lastname: Ussowicz
authors.forename: J
authors.initials: J
authors.lastname: Musiał
authors.forename: M
authors.initials: M
authors.lastname: Mielcarek
authors.forename: A
authors.initials: A
authors.lastname: Tomaszewska
authors.forename: B
authors.initials: B
authors.lastname: Nasiłowska-Adamska
authors.forename: K
authors.initials: K
authors.lastname: Kałwak
authors.forename: E
authors.initials: E
authors.lastname: Gorczyńska
authors.forename: B
authors.initials: B
authors.lastname: Mariańska
authors.forename: A
authors.initials: A
authors.lastname: Chybicka
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006086:Graft vs Host Disease / Q000503:physiopathology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017893:Photopheresis; D014184:Transplantation, Homologous