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Br J Nurs. 2019 Jun 13;28(11):698-701. doi: 10.12968/bjon.2019.28.11.698.

Adrenal insufficiency of patients with graft versus host disease treated with extracorporeal photopheresis.

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Specialist Nurse Photopheresis, The Rotherham NHS Foundation Trust, Rotherham.
Research Assistant, The Rotherham NHS Foundation Trust, Rotherham.
Consultant Clinical Scientist, The Rotherham NHS Foundation Trust, Rotherham.
Consultant Haematologist, The Rotherham NHS Foundation Trust, Rotherham.


Graft versus host disease (GvHD) is a serious and common complication of allogenic haematopoietic stem cell transplant. Corticosteroids are considered the standard care for initial treatment of GvHD but a significant proportion of patients will need long-term steroid treatment for control of GvHD. Extracorporeal photopheresis (ECP) is a cell-based immunomodulatory therapy that is an accepted second line treatment in patients with steroid refractory, dependent or intolerant GvHD and has shown efficacy in allowing steroid dose reduction and discontinuation in this cohort of patients. Adrenal cortical insufficiency is defined by the inability of the adrenal cortex to produce sufficient amounts of glucocorticoids and/or mineralocorticoids leading to a severe and potentially life-threatening condition. The most common cause of drug-induced adrenal insufficiency is the suppression of the hypothalamic-pituitary-adrenal axis by exogenous glucocorticoid doses ≥5 mg prednisolone equivalent for more than 4 weeks. The aim of the study was to ascertain the number of patients with GvHD receiving ECP that are affected by adrenocortical insufficiency.


ACTH stimulation test; Adrenal insufficiency; Extracorporeal photopheresis; Graft versus host disease

[Indexed for MEDLINE]

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