title: Extracorporeal Photopheresis for Treatment of Acute and Chronic Graft Versus Host Disease: An Italian Multicentric Retrospective Analysis on 94 Patients on Behalf of the Gruppo Italiano Trapianto di Midollo Osseo.
abstract: BACKGROUND
  Extracorporeal photopheresis (ECP) is considered a valid second-line treatment for acute and chronic graft versus host disease (GVHD).
  
  
  METHODS
  Ninety-four patients with acute GVHD (aGVHD) (n = 45) and chronic GVHD (cGVHD) (n = 49), retrospectively recruited in 6 Italian centers, were submitted to ECP for second-line treatment. At the time of ECP, 22 (49%) and 23 (51%) of 45 patients with aGHVD were nonresponsive and in partial remission (PR) after steroids, respectively, and all the 49 patients with cGVHD were steroid refractory.
  
  
  RESULTS
  Forty-one (91%) of 45 patients with aGVHD achieved complete remission (CR) after ECP. Fifteen (33%) of 45 patients developed cGVHD. The CR rate in patients who started ECP being nonresponsive and in PR after steroid was 86% and 96%, respectively. After a median follow-up of 20 months (range, 2-72), 15 (33%) of 45 patients developed cGHVD and 16 (35%) of 45 patients died, in 3 cases for aGVHD. A trend for a better survival was seen among patients who started ECP in PR after steroid (80% vs 50% at 2 years; P = 0.07). Overall, 22 (45%) of 49 patients and 17 (35%) of 49 patients with steroid refractory cGHVD achieved CR and PR after ECP, respectively. After a median follow-up of 27 months, 44 (90%) of 49 patients are alive, 21 of whom (48%) are on steroid.
  
  
  CONCLUSIONS
  Extracorporeal photopheresis is confirmed as an effective second-line treatment in both aGVHD and cGVHD, because it can induce a response in more than 80% of the patients and a long-term survival in at least 50% of the cases.
authors.affiliation: 1 Hematology, Bone Marrow Transplantation Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy. 2 Immunohematology and Transfusion Medicine Unit, AO Spedali Cvili, Brescia, Italy. 3 SODc Terapia Cellulare e Medicina Trasfusionale, AOU Careggi, Firenze, Italy. 4 Divisione di Ematologia, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy. 5 SC Ematologia, Istituto Nazionale Tumori, Milano, Italy. 6 Clinica Ematologica e Unità di terapie Cellulari, DISM, Università di Udine, Italy. 7 Centro di Ricerca Emato-oncologica AIL (CREA) Brescia, AO Spedali Civili di Brescia, Italy. 8 Unità di Cellule Staminali, Istituto Europeo di Oncologia, Milano, Italy. 9 Medicina Trasfusionale, Azienda Ospedaliero-Universitaria di Udine, Italy. 10 UO di Emotrasfusione, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy. 11 Bone Marrow Transplant Unit SODc Ematologia, AOU Careggi, Firenze, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Malagola
authors.forename: Valeria
authors.initials: V
authors.lastname: Cancelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Skert
authors.forename: Pierino Ferremi
authors.initials: PF
authors.lastname: Leali
authors.forename: Emilio
authors.initials: E
authors.lastname: Ferrari
authors.forename: Alessandra
authors.initials: A
authors.lastname: Tiburzi
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Sala
authors.forename: Irene
authors.initials: I
authors.lastname: Donnini
authors.forename: Patrizia
authors.initials: P
authors.lastname: Chiusolo
authors.forename: Alberto
authors.initials: A
authors.lastname: Mussetti
authors.forename: Marta
authors.initials: M
authors.lastname: Battista
authors.forename: Alessandro
authors.initials: A
authors.lastname: Turra
authors.forename: Federica
authors.initials: F
authors.lastname: Cattina
authors.forename: Benedetta
authors.initials: B
authors.lastname: Rambaldi
authors.forename: Francesca
authors.initials: F
authors.lastname: Schieppati
authors.forename: Nicola
authors.initials: N
authors.lastname: Polverelli
authors.forename: Simona
authors.initials: S
authors.lastname: Bernardi
authors.forename: Simone
authors.initials: S
authors.lastname: Perucca
authors.forename: Mirella
authors.initials: M
authors.lastname: Marini
authors.forename: Daniele
authors.initials: D
authors.lastname: Laszlo
authors.forename: Chiara
authors.initials: C
authors.lastname: Savignano
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
authors.forename: Nicola
authors.initials: N
authors.lastname: Piccirillo
authors.forename: Simona
authors.initials: S
authors.lastname: Sica
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007249:Inflammation; D007558:Italy; D008297:Male; D008875:Middle Aged; D017893:Photopheresis / Q000379:methods*; D012074:Remission Induction; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013256:Steroids