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Extracorporeal Photopheresis for Treatment of Acute and Chronic Graft Versus Host Disease

2016; Wolters Kluwer; Volume: 100; Issue: 12 Linguagem: Inglês

10.1097/tp.0000000000001466

1534-6080

Michele Malagola, Valeria Cancelli, Cristina Skert, Pierino Ferremi Leali, Emilio Ferrari, Alessandra Tiburzi, Maria Luisa Sala, Irene Donnini, Patrizia Chiusolo, Alberto Mussetti, Marta Lisa Battista, Alessandro Turra, Federica Cattina, Benedetta Rambaldi, Francesca Schieppati, Nicola Polverelli, Simona Bernardi, Simone Perucca, Mirella Marini, Daniele Laszlò, Chiara Savignano, Francesca Patriarca, Paolo Corradini, Nicola Piccirillo, Simona Sica, Alberto Bosi, Domenico Russo,

Virus-based gene therapy research

Extracorporeal photopheresis (ECP) is considered a valid second-line treatment for acute and chronic graft versus host disease (GVHD).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.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.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.