title: Extracorporeal photopheresis for graft-versus-host disease: the role of patient, transplant, and classification criteria and hematologic values on outcome-results from a large single-center study.
abstract: BACKGROUND
  Extracorporeal photopheresis (ECP) has been shown as active therapy for graft-versus-host disease (GVHD).
  
  
  METHODS
  The aim was to ascertain the role of ECP in 71 patients with steroid-refractory or -dependent acute and chronic GVHD (aGVHD and cGVHD) with special focus on hematologic variables and GVHD staging classification. A total of 34 patients were treated for aGVHD and 37 for cGVHD.
  
  
  RESULTS
  The overall response rate (ORR) for aGVHD was 65% and the complete aGVHD-free survival was 50% (95% confidence interval [CI], 36%-70%). The ORR for cGVHD response was 81% while the complete cGVHD-free survival was 50% (95% CI, 34%-73%). The aGVHD-free survival was associated with aGVHD grading (Grade II 81%, Grade III 33%, and Grade IV 0%, p ≤ 0.00) and the absence of visceral involvement (77% vs. 33%, p = 0.03). The cGVHD-free survival was associated with the female sex (67% vs. 25%, p = 0.01) and with the limited form according to the Seattle classification (67% vs. 20%, p = 0.003). No role for hematologic values or apheresis cell count was found, except for the cGVHD ORR (p = 0.037). Transplant-related mortality and overall survival were associated with ECP response 0% versus 54% (p = 0.0001) and 77% versus 45% (p = 0.03) for aGVHD patients and 7% versus 14% (p = 0.02) and 73% versus 20% (p = 0.0003) for cGVHD patients, respectively.
  
  
  CONCLUSIONS
  While confirming a higher probability of GVHD responses for early GVHD, our study shows no role of hematologic values or apheresis cell count on GVHD response.
authors.affiliation: Pediatric Onco-Hematology and Stem Cell Transplant Division, Regina Margherita Children's Hospital, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Berger
authors.affiliation: Immunohematology and Transfusion Medicine, Regina Margherita Children's Hospital, Turin, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Albiani
authors.affiliation: Immunohematology and Transfusion Medicine, Regina Margherita Children's Hospital, Turin, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Sini
authors.affiliation: Pediatric Onco-Hematology and Stem Cell Transplant Division, Regina Margherita Children's Hospital, Turin, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Fagioli
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D015415:Biomarkers; D001787:Blood Group Incompatibility / Q000453:epidemiology; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D004351:Drug Resistance; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D019337:Hematologic Neoplasms / Q000097:blood / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D017893:Photopheresis; D011446:Prospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D007166:Immunosuppressive Agents