title: Extracorporeal photopheresis in steroid-refractory acute or chronic graft-versus-host disease: results of a systematic review of prospective studies.
abstract: Acute and chronic graft-versus-host disease (GVHD) remain major obstacles for successful allogeneic hematopoietic cell transplantation. Extracorporeal photopheresis (ECP) modulates immune cells, such as alloreactive T cells and dendritic cells, and improves GVHD target organ function(s) in steroid-refractory GVHD patients. We performed a systematic review to evaluate the totality of evidence regarding the efficacy of ECP for treatment of acute and chronic steroid-refractory or steroid-dependent GVHD. Nine studies, including 1 randomized controlled trial, met inclusion criteria, with a total of 323 subjects. In pooled analyses, overall response rates (ORR) were .69 (95% confidence interval [CI], .34 to .95) and .64 (95% CI, .47 to .79) for acute and chronic GVHD, respectively. In acute GVHD organ-specific responses, ECP resulted in the highest ORR for cutaneous, with .84 (95% CI, .75 to .92), followed by gastrointestinal with .65 (95% CI, .52 to .78). Similar response rates were seen in chronic GVHD involving the skin and gastrointestinal tract. Conversely, ORR for chronic GVHD involving the lungs was only .15 (95% CI, 0 to .5). In chronic GVHD, grades 3 to 4 adverse events were reported at .38 (95% CI, .06 to .78). ECP-related mortality rates were extremely low. Rates of immunosuppression discontinuation were .55 (95% CI, .40 to .70) and .23 (95% CI, .07 to .44) for acute and chronic GVHD, respectively. In summary, albeit limited by numbers of available studies, pooled analyses of prospective studies demonstrate encouraging responses after ECP treatment in acute and chronic GVHD after failing corticosteroids. Further research efforts are needed to improve organ-specific responses.
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Iman
authors.initials: I
authors.lastname: Abu-Dalle
authors.affiliation: Center for Evidence Based Medicine, University of South Florida College of Medicine, Tampa, Florida.
authors.forename: Tea
authors.initials: T
authors.lastname: Reljic
authors.affiliation: Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Florida; Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Taiga
authors.initials: T
authors.lastname: Nishihori
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Antar
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Ali
authors.initials: A
authors.lastname: Bazarbachi
authors.affiliation: Center for Evidence Based Medicine, University of South Florida College of Medicine, Tampa, Florida; Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Florida; Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Djulbegovic
authors.affiliation: Center for Evidence Based Medicine, University of South Florida College of Medicine, Tampa, Florida.
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Florida; Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida. Electronic address: Mohamed.Kharfan-Dabaja@Moffitt.org.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Kharfan-Dabaja
mesh_terms: D000208:Acute Disease; D000328:Adult; D002648:Child; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017893:Photopheresis / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult
keywords: Acute; Chronic; Extracorporeal photopheresis; Graft-versus-host disease