title: Extracorporeal photopheresis for chronic graft-versus-host disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  The safety of extracorporeal photopheresis (ECP) in steroid-refractory chronic graft-versus-host disease (SR-cGVHD) has been explored in multiple studies but reported response rates (RR) vary significantly across studies.
  
  
  METHODS
  We conducted a meta-analysis to assess the efficacy of ECP for SR-cGVHD. A search of electronic databases for studies published between 1984 and 2012 was conducted. End points included RR: complete response (CR), overall response rates (ORR), and organ-specific RR. The initial search generated 312 studies, of which 18 met the selection criteria (N=595). A random effects model was used for pooled rates.
  
  
  RESULTS
  Pooled CR rates and ORR were 29% (confidence interval [CI], 19-42%) and 64% (CI, 65-82%), respectively. One-year overall survival was available for 4 studies only and was 49% (CI, 29-70%). The pooled RR for skin, liver, ocular, oral, lung, gastrointestinal and musculoskeletal SR-cGVHD was 74%, 68%, 60%, 72%, 48%, 53%, and 64%, respectively. There was a significant heterogeneity among studies due to differences in ECP schedules and duration. No significant differences in responses to ECP for pediatric and adult populations were found. Sensitivity analysis could not be undertaken due to a limited number of prospective studies.
  
  
  CONCLUSIONS
  ECP is an effective therapy for oral, skin, and liver SR-cGVHD, with modest activity in lung and gastrointestinal SR-cGVHD.
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, USA.
authors.forename: Mohsin Ilyas
authors.initials: MI
authors.lastname: Malik
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Litzow
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, USA.
authors.forename: William
authors.initials: W
authors.lastname: Hogan
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, USA.
authors.forename: Mrinal
authors.initials: M
authors.lastname: Patnaik
authors.affiliation: Division of Preventive, Occupation and Aerospace Medicine, Mayo Clinic, Rochester, USA.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Library and Public Services, Mayo Clinic, Rochester, USA.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, USA.
authors.forename: Shahrukh
authors.initials: S
authors.lastname: Hashmi
keywords: Extracorporeal photopheresis; Graft-versus-host disease; Meta-analysis