title: Response of steroid-refractory chronic graft-versus-host disease to extracorporeal photopheresis correlates with the dose of CD3+ lymphocytes harvested during early treatment cycles.
abstract: BACKGROUND
  Extracorporeal photopheresis (ECP) is a recognized second-line treatment for steroid-refractory chronic graft-versus-host disease (cGVHD). Treatment course is usually long, expensive, and demanding for patients, so predictors for response are needed. We carried out a retrospective study on cGVHD patients treated at our institution with the aim to identify a possible correlation between apheretic yields composition and probability of response.
  
  
  METHODS
  Patients treated for at least 6 months were eligible for the study. Flow cytometry data, including absolute counts of lymphocytes and their subpopulations in ECP products from cGVHD patients, were collected. For each cell population 1) the median dose per procedure harvested during the first 3 months of treatment and 2) the cumulative dose collected in the same period were compared with clinical response.
  
  
  RESULTS
  A total of 726 ECP procedures were performed in 15 patients. Overall response, defined as either a complete response (CR) or a partial response according to National Institutes of Health criteria, was obtained in 10 of 15 patients (66.7%), and CR, in eight of 15 (53.3%). According to Cox regression analysis, the probability of achieving an overall response is significantly correlated with the median number of CD3+, CD3+CD4+, and CD3+CD8+ lymphocytes collected during the early treatment phase (first 3 months).
  
  
  CONCLUSIONS
  Our data suggest that CD3+ cell evaluation in ECP during the early phase of treatment course could predict response and help identify patients who deserve further treatment.
authors.affiliation: Transfusion Medicine Department, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Giambattista
authors.initials: G
authors.lastname: Bertani
authors.affiliation: Transfusion Medicine Department, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Santoleri
authors.affiliation: Transfusion Medicine Department, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Ursula
authors.initials: U
authors.lastname: Ferri
authors.affiliation: Bone Marrow Transplantation Unit, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Marenco
authors.affiliation: Bone Marrow Transplantation Unit, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grillo
authors.affiliation: Bone Marrow Transplantation Unit, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Zucchetti
authors.affiliation: Bone Marrow Transplantation Unit, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Forno
authors.affiliation: Transfusion Medicine Department, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Lando
authors.affiliation: Transfusion Medicine Department, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Scarpati
authors.affiliation: Hematology Department, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cairoli
authors.affiliation: Transfusion Medicine Department, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Rossini
authors.affiliation: Transfusion Medicine Department, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Cesana
mesh_terms: D000328:Adult; D017252:CD3 Complex / Q000097:blood*; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism*; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism*; D002908:Chronic Disease; D004351:Drug Resistance; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017893:Photopheresis / Q000379:methods*; D013256:Steroids
chemical_list: D017252:CD3 Complex; D013256:Steroids