Extracorporeal photopheresis in prevention and treatment of acute GVHD.
Acute graft versus host disease (GVHD), a common complication after allogeneic hematopoietic cell transplantation (HCT), occurs in as many as 70% of recipients of this life saving treatment. Front line therapy for GVHD with corticosteroids will fail in up to 40% of patients, which leads to high morbidity and mortality. Traditional prevention and treatment strategies have focused on reducing alloreactivity, typically with therapy to reduce cytotoxic T-cell function. Emerging evidence exists that promotion of regularly T-cell function, through treatments such as extracorporeal photopheresis, is effective for GVHD treatment and has potential for prevention as well. This review will focus on literature reporting the success of ECP for steroid refractory acute GVHD and the potential for delivery of ECP in the early pre and post-transplant periods that shows promise as a less immunosuppressive strategy to reduce rates of acute GVHD.
Blood and Marrow Transplant Program, Division of Pediatric Hematology/Oncology, University of Michigan, 1500 E. Medical Center Dr. MPB 4202, Ann Arbor, MI 48109-5718. Electronic address: ckitko@med.umich.edu.
Carrie L
CL
Kitko
Blood and Marrow Transplant Program, Division of Pediatric Hematology/Oncology, University of Michigan, 1500 E. Medical Center Dr. MPB 4202, Ann Arbor, MI 48109-5718.
John E
JE
Levine
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000818:Animals; D017209:Apoptosis; D016207:Cytokines / Q000378:metabolism; D006086:Graft vs Host Disease / Q000517:prevention & control* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007249:Inflammation; D051379:Mice; D017893:Photopheresis / Q000379:methods*; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D016207:Cytokines