Extracorporeal photopheresis in the management of graft-versus-host disease.
OBJECTIVE
Is there a benefit associated with the use of extracorporeal photopheresis (ecp) compared with other treatment options for patients who have received allogeneic stem-cell transplantation (sct) and are experiencing graft-versus-host disease (gvhd), if response rate, survival, or improvement in symptoms are the outcomes of interest?


CONCLUSIONS
After allogeneic sct, gvhd is a common complication historically categorized as either acute (agvhd: onset ≤100 days post-transplantation) or chronic (cgvhd: >100 days post-transplantation). Graft-versus-host disease occurs when the donor's immune cells recognize the host patient's tissues and organs as foreign and attack them, causing a multitude of problems, often in liver, gastrointestinal system, and skin. Photopheresis is one therapy that has emerged since the early 2000s for the management of steroid-refractory gvhd because of its steroid-sparing ability, low associated toxicity, and efficacy in some clinical settings. The present recommendation report summarizes the available data about photopheresis for the treatment of gvhd and provides recommendations on its use.


METHODS
The medline (Ovid) database was systematically searched for January 1995 to August 2013, and the best available evidence was used to draft recommendations relevant to adult and pediatric patients in Ontario who have received allogeneic sct and are experiencing gvhd. Draft recommendations were first reviewed by clinical and methodology experts before undergoing internal review. Final approval of this practice guideline report was obtained from both the Stem Cell Transplant Steering Committee and the Report Approval Panel of the Program in Evidence-Based Care.


CONCLUSIONS
These recommendations apply to adult and pediatric patients who have received an allogeneic sct and are experiencing gvhd: ecp is an acceptable therapy for the treatment of steroid-dependent or refractory agvhd in adult and pediatric patients.ecp is an effective therapy for the treatment of steroid-dependent or refractory cgvhd in adult and pediatric patients.
In Ontario, ecp is currently a covered therapy for patients with steroid-refractory gvhd who meet certain eligibility criteria.
The Ottawa Hospital Research Institute, and Department of Medicine, University of Ottawa, Ottawa, ON.
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Bredeson
American Society of Clinical Oncology, Alexandria, VA, U.S.A. (The opinions expressed in this article are those of the authors and do not necessarily represent the views of the American Society of Clinical Oncology.).
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Rumble
Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, ON.
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Varela
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON.
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Kuruvilla
Division of Malignant Hematology, Juravinski Cancer Centre, McMaster University, Department of Oncology, Hamilton, ON.
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Kouroukis
Stem-cell transplantation; bone marrow; graft-versus-host disease; peripheral blood; photopheresis