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Graft-versus-host Disease

Treating refractory chronic graft-versus-host disease with extracorporeal photochemotherapy

Bone Marrow Transplantation volume 31, pages 291–294 (2003)Cite this article

Summary:

Extracorporeal photochemotherapy (ECP; photopheresis), an immunomodulatory therapy, has previously demonstrated promising results in treating chronic graft-versus-host disease (cGvHD). We treated six patients (ages 33–54 years) with long-standing refractory extensive-stage cGvHD. ECP was performed thrice weekly initially in all patients. Concomitant therapies included prednisone (n=6), tacrolimus (n=5), cyclosporin A (n=2), hydroxychloroquine (n=2), mycophenolate mofetil (n=1), and psoralen plus ultraviolet A radiation (n=1). After an average of 7.2 months (range, 2–13 months) of ECP, all patients experienced either improvement or stabilization in sclerodermatous skin changes, as well as partial improvements in liver enzyme levels. Skin softening occurred in four patients and was noted as early as 3–8 weeks into treatment. Two patients were able to taper steroid therapy, and two patients were able to taper ECP to twice weekly. ECP was well tolerated. Our results support those of previous studies, suggesting that ECP may be beneficial in patients with refractory cGvHD.

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References

  1. Ratanatharathorn V, Ayash L, Lazarus HM et al. Chronic graft-versus-host disease: clinical manifestation and therapy. Bone Marrow Transplant 2001; 28: 121–129.

    Article  CAS  PubMed  Google Scholar 

  2. Shulman HM, Sullivan KM, Weiden PL et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204–217.

    Article  CAS  PubMed  Google Scholar 

  3. Perreault C, Decary F, Brochu S et al. Minor histocompatibility antigens. Blood 1990; 76: 1269–1280.

    CAS  PubMed  Google Scholar 

  4. Gaziev D, Lucarelli G . Novel approaches to the treatment of chronic graft-versus-host disease. Expert Opin Investig Drugs 2001; 10: 909–923.

    Article  CAS  PubMed  Google Scholar 

  5. Wingard JR, Piantadosi S, Vogelsang GB et al. Predictors of death from chronic graft-versus-host disease after bone marrow transplantation. Blood 1989; 74: 1428–1435.

    CAS  PubMed  Google Scholar 

  6. Edelson R, Berger C, Gasparro F et al. Treatment of cutaneous T-cell lymphoma by extracorporeal photochemotherapy. Preliminary results. N Engl J Med 1987; 316: 297–303.

    Article  CAS  PubMed  Google Scholar 

  7. Rook AH, Suchin KR, Kao DM et al. Photopheresis: clinical applications and mechanism of action. J Investig Dermatol Symp Proc 1999; 4: 85–90.

    Article  CAS  PubMed  Google Scholar 

  8. Owsianowski M, Gollnick H, Siegert W et al. Successful treatment of chronic graft-versus-host disease with extracorporeal photopheresis. Bone Marrow Transplant 1994; 14: 845–848.

    CAS  PubMed  Google Scholar 

  9. Rossetti F, Dall'Amico R, Crovetti G et al. Extracorporeal photochemotherapy for the treatment of graft-versus-host disease. Bone Marrow Transplant 1996; 18 (Suppl. 2): 175–181.

    PubMed  Google Scholar 

  10. Child FJ, Ratnavel R, Watkins P et al. Extracorporeal photopheresis (ECP) in the treatment of chronic graft-versus-host disease (GVHD). Bone Marrow Transplant 1999; 23: 881–887.

    Article  CAS  PubMed  Google Scholar 

  11. Greinix HT, Volc-Platzer B, Rabitsch W et al. Successful use of extracorporeal photochemotherapy in the treatment of severe acute and chronic graft-versus-host disease. Blood 1998; 92: 3098–3104.

    CAS  PubMed  Google Scholar 

  12. Alcindor T, Gorgun G, Miller KB et al. Immunomodulatory effects of extracorporeal photochemotherapy in patients with extensive chronic graft-versus-host disease. Blood 2001; 98: 1622–1625.

    Article  CAS  PubMed  Google Scholar 

  13. Schwartz J, Gonzalez J, Palangio M et al. Extracorporeal photochemotherapy in progressive systemic sclerosis: a follow-up study. Int J Dermatol 1997; 36: 380–385.

    Article  CAS  PubMed  Google Scholar 

  14. Vogelsang GB . How I treat chronic graft-versus-host disease. Blood 2001; 97: 1196–1201.

    Article  CAS  PubMed  Google Scholar 

  15. Girardi M, Herreid P, Tigelaar RE . Specific suppression of lupus-like graft-versus-host disease using extracorporeal photochemical attenuation of effector lymphocytes. J Invest Dermatol 1995; 104: 177–182.

    Article  CAS  PubMed  Google Scholar 

  16. Foss FM, Gorgun G, Miller KB . Extracorporeal photopheresis in chronic graft-versus-host disease. Bone Marrow Transplant 2002; 29: 719–725.

    Article  CAS  PubMed  Google Scholar 

  17. Parkman R . Chronic graft-versus-host disease. Curr Opin Hematol 1998; 5: 22–25.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Columbia University College of Physicians and Surgeons, New York, New York, USA

    E Bisaccia

  2. Section of Photopheresis, Morristown Memorial Hospital, Morristown, NJ, USA

    E Bisaccia, M Palangio & J Gonzalez

  3. Section of Hematology and Oncology, Morristown Memorial Hospital, Morristown, NJ, USA

    K R Adler

  4. Adult Blood and Marrow Transplant Program, Hackensack University Medical Center, Hackensack, NJ, USA

    S D Rowley & S L Goldberg

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  1. E Bisaccia
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  2. M Palangio
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  4. K R Adler
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  5. S D Rowley
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  6. S L Goldberg
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Bisaccia, E., Palangio, M., Gonzalez, J. et al. Treating refractory chronic graft-versus-host disease with extracorporeal photochemotherapy. Bone Marrow Transplant 31, 291–294 (2003). https://doi.org/10.1038/sj.bmt.1703830

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  • DOI: https://doi.org/10.1038/sj.bmt.1703830

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