title: Extracorporeal photopheresis in solid organ transplant-associated acute graft-versus-host disease.
abstract: BACKGROUND
  Extracorporeal photopheresis (ECP) culls pathogenic T lymphocytes, be these the clones of cutaneous T-cell lymphoma, or mediators of chronic graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation (BMT-GVHD). Whether or not ECP may have an effect in the rarer instances of solid organ transplantation-associated GVHD (SOT-GVHD) is unclear. Mortality rates in SOT-GVHD rival those of transfusion-associated GVHD, with fatalities preceded by pancytopenia and peripheral blood chimerism (PBC) levels exceeding 20%. ECP has been described in two SOT-GVHD cases to date, with one surviving.
  
  
  METHODS
  Clinicolaboratory features (including HLA relationships) in a case of multivisceral transplantation were reviewed from the time of surgery to the onset and progression of SOT-GVHD. ECP, which was introduced as a less immunosuppressive and more selective intervention, was assessed for its effect on serial PBC (as measured by short-tandem-repeat analysis) and clinical outcome.
  
  
  RESULTS
  Multivisceral SOT-GVHD manifested with erythroderma, neutropenic sepsis, and PBC increasing from 6% on Posttransplant Day (PTD) 38 to 78% by PTD 60 (at a doubling time of 6 days despite corticosteroids). ECP was administered on PTDs 62 and 67 and was associated with the first evidence of PBC decay to 67% on PTD 69. Death nevertheless ensued on the last day of salvage antithymocyte globulin (PTDs 69-73) despite further PBC reduction to 41%.
  
  
  CONCLUSIONS
  Further study is needed to determine if the sooner or more frequent application of ECP might attenuate the high case fatality rates of SOT-GVHD.
authors.affiliation: Department of Medicine.
authors.forename: Brett L
authors.initials: BL
authors.lastname: Houston
authors.affiliation: Department of Medical Oncology and Hematology, University of Toronto.
authors.forename: Matthew
authors.initials: M
authors.lastname: Yan
authors.affiliation: Department of Medicine.|Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Tinckam
authors.affiliation: Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Kamel-Reid
authors.affiliation: Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario.
authors.forename: Hong
authors.initials: H
authors.lastname: Chang
authors.affiliation: Department of Medicine.|Department of Medical Oncology and Hematology, University of Toronto.
authors.forename: Kevin H M
authors.initials: KH
authors.lastname: Kuo
authors.affiliation: Department of Medicine.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Tsien
authors.affiliation: Department of Medical Oncology and Hematology, CancerCare Manitoba, and Section of Hematology/Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Seftel
authors.affiliation: Department of Paediatrics, Hospital for Sick Children, Toronto.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Avitzur
authors.affiliation: Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Grant
authors.affiliation: Department of Medicine.|Department of Medical Oncology and Hematology, University of Toronto.|Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Cserti-Gazdewich
mesh_terms: D000208:Acute Disease; D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D016377:Organ Transplantation / Q000009:adverse effects*; D017893:Photopheresis / Q000379:methods*