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Graft-Versus-Host Disease

Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation: feasibility and results

Bone Marrow Transplantation volume 31, pages 459–465 (2003)Cite this article

Summary:

We conducted a retrospective analysis of all allogeneic stem cell transplantation (ASCT) patients started on extracorporeal photopheresis (ECP) for the management of steroid-dependent (SD) or steroid-refractory (SR) cutaneous chronic graft-versus-host disease (cGVHD) following ASCT during a 36-month period (9/98–8/01). Only SD or SR patients who were treated by ECP after day 100 and who received at least 4 weeks of ECP were considered evaluable for this analysis. Out of 64 ASCT patients reviewed, 32 patients met the inclusion criteria. All 32 patients had been previously treated with systemic corticosteroids with 11 (34%) being SR and 21 (66%) SD. Cutaneous cGVHD was extensive in 28 patients (88%) and was accompanied by visceral (hepatic, gastrointestinal) cGVHD in 23 patients (72%). The 32 evaluated patients had received a median of three prior therapies before ECP, most commonly systemic corticosteroids, tacrolimus, and mycophenolate mofetil. Patients received a median of 36 ECP sessions (range 12–98) over a median of 5.3 months (range 1–28), with a median of six sessions per month. The complete response (CR) rate was 22% (n=7) and the partial response rate was 34% (n=11). In all, 28 patients were on systemic corticosteroid therapy at ECP initiation and 18 patients achieved 50% dose reduction while on ECP, yielding a 64% steroid-sparing response rate. Of seven CRs, five are ongoing. A total of 11 (34%) patients have died after ECP, with all cases due to visceral cGVHD or cGVHD-related infectious complications. All 21 surviving patients remain on at least some immunosuppressive cGVHD therapy (including ECP in eight). Overall, ECP displays a substantial response rate and, in particular, steroid-sparing activity in SR/SD extensive cutaneous cGVHD. However, most patients continue to require at least some chronic therapy and cGVHD-related morbidity and mortality remain high.

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Acknowledgements

This study was supported in part by an unrestricted educational grant from Therakos, Inc., and was presented in part at the American Society of Hematology 43rd Annual Meeting, December 2001 in Orlando, FL, USA.

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Authors and Affiliations

  1. Department of Dermatology, MD Anderson Cancer Center, Houston, TX, USA

    N Apisarnthanarax & M Duvic

  2. Department of Blood and Marrow Transplantation, MD Anderson Cancer Center, Houston, TX, USA

    M Donato, M Körbling, D Couriel, J Gajewski, S Giralt, I Khouri, C Hosing, R Champlin & P Anderlini

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  1. N Apisarnthanarax
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  2. M Donato
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  7. I Khouri
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  9. R Champlin
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Apisarnthanarax, N., Donato, M., Körbling, M. et al. Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation: feasibility and results. Bone Marrow Transplant 31, 459–465 (2003). https://doi.org/10.1038/sj.bmt.1703871

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