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Biol Blood Marrow Transplant. 2020 Jan 7. pii: S1083-8791(20)30001-X. doi: 10.1016/j.bbmt.2019.12.769. [Epub ahead of print]

Retrospective Multicenter Study of Extracorporeal Photopheresis in Steroid-Refractory Acute and Chronic Graft-versus-Host Disease.

Author information

1
Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.
2
Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain; Centro Regional de Hemodonación, Murcia, Spain; School of Medicine, University of Murcia, Murcia, Spain; Instituto Murciano de Investigación Biomédica-Arrixaca, Murcia, Spain.
3
Department of Hematology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain.
4
Banco de Sangre y Tejidos de Cantabria-Hospital Universitario Marqués de Valdecilla, Santander, Spain.
5
Department of Hematology, Complexo Hospitalario Universitario, A Coruña, Spain.
6
Department of Hematology and Hemotherapy, Hospital Universitario Central de Asturias, Oviedo, Spain.
7
Department of Hematology, Hospital Universitario La Paz, Madrid, Spain.
8
Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain; School of Medicine, Complutense University of Madrid, Madrid, Spain.
9
Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain. Electronic address: crisizquierdo3@yahoo.es.

Abstract

Extracorporeal photopheresis (ECP) is an established treatment strategy in steroid-refractory graft-versus-host disease (GVHD). This study's main objective was to analyze the clinical response and impact of ECP therapy in steroid dose reduction. A retrospective observational series of 113 patients from 7 transplantation centers was analyzed. Sixty-five patients (58%) had acute GVHD (aGVHD), and 48 (42%) had chronic GVHD (cGVHD). All ECP procedures were performed with the off-line system. The median number of procedures until achievement of initial response was 3 for both patients with aGVHD and those with cGVHD. ECP was the second-line therapy in 48% of the aGVHD cases and in 50% of the cGVHD cases. 71% of the cases of aGVHD were grade III-IV, and 69% of the cases of cGVHD were severe. The overall response rate on day 28 was 53% (complete response [CR] rate, 45%) in the patients with aGVHD and 67% (CR, 23%) in those with cGVHD. Skin was the most frequently involved organ, with a response rate of 58% (CR, 49%) in the patients with aGVHD and 69% (CR 29%) in those with cGVHD. At the end of ECP treatment, 60% of patients treated for aGVHD who responded were able to stop steroid therapy, with a median dose reduction of 100%. Significant differences in overall survival were observed for patients responding to ECP with aGVHD (hazard ratio [HR], 4.3; P < .001) and with cGVHD (HR, 4.8; P = .003). Our data indicate that ECP is a valid therapeutic alternative in patients with steroid-refractory aGVHD and cGVHD, permitting significant steroid dosage reductions.

KEYWORDS:

Acute graft-versus-host disease; Allogenic stem cell transplantation; Chronic graft-versus-host disease; Extracorporeal photopheresis; Off-line system

PMID:
31917270
DOI:
10.1016/j.bbmt.2019.12.769

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