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Graft-Versus-Host Disease

Extracorporeal photopheresis for the prevention of acute GVHD in patients undergoing standard myeloablative conditioning and allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 45, pages 1068–1076 (2010)Cite this article

Abstract

GVHD is partly mediated by host APCs that activate donor T cells. Extracorporeal photopheresis (ECP) can modulate APC function and benefit some patients with GVHD. We report the results of a study using ECP administered before a standard myeloablative preparative regimen intended to prevent GVHD. Grades II–IV acute GVHD developed in 9 (30%) of 30 recipients of HLA-matched related transplants and 13 (41%) of 32 recipients of HLA-matched unrelated or HLA-mismatched related donor transplants. Actuarial estimates of overall survival (OS) at day 100 and 1-year post transplant were 89% (95% CI, 78–94%) and 77% (95% CI, 64–86%), respectively. There were no unexpected adverse effects of ECP. Historical controls receiving similar conditioning and GVHD prophylaxis regimens but no ECP were identified from the database of the Center for International Blood and Marrow Transplant Research and multivariate analysis indicated a lower risk of grades II–IV acute GVHD in patients receiving ECP (P=0.04). Adjusted OS at 1 year was 83% in the ECP study group and 67% in the historical control group (relative risk 0.44; 95% CI, 0.24–0.80) (P=0.007). These preliminary data may indicate a potential survival advantage with ECP for transplant recipients undergoing standard myeloablative hematopoietic cell transplantation.

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Acknowledgements

The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA76518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a contract HHSH234200637015C with Health Resources and Services Administration (HRSA/DHHS); and, two Grants N00014-06-1-0704 and N00014-08-1-0058 from the Office of Naval Research. Therakos, Inc. sponsored the study and provided data collection and monitoring of study patients. The authors would like to thank Dr Jan Rogers for his help in preparing this manuscript.

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Authors and Affiliations

  1. Texas Transplant Institute, San Antonio, TX, USA

    P J Shaughnessy

  2. Cleveland Clinic Foundation, Cleveland, OH, USA

    B J Bolwell

  3. University of Chicago, Chicago, IL, USA

    K van Besien

  4. Department of Hematology and Transfusion, University Hospital, Bratislava, Slovakia

    M Mistrik

  5. Royal Melbourne Hospital, Melbourne, Australia

    A Grigg

  6. St Vincents Hospital, Sydney, Australia

    A Dodds

  7. Peter MacCallum Cancer Institute and University of Melbourne, Melbourne, Australia

    H M Prince

  8. Royal Brisbane Hospital, Brisbane, Australia

    S Durrant

  9. Ankara University Medical School, Ankara, Turkey

    O Ilhan

  10. Therakos, Exton, PA, USA

    D Parenti & J Gallo

  11. Yale Cancer Center, Hew Haven, CT, USA

    F Foss

  12. Hammersmith Hospital Imperial College, London, UK

    J Apperley

  13. Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA

    M-J Zhang & M M Horowitz

  14. University of Kansas Medical Center, Kansas City, KS, USA

    S Abhyankar

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  1. P J Shaughnessy
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Correspondence to P J Shaughnessy.

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Competing interests

Dennis Parenti and Jose Gallo are employees of Therakos. Paul Shaughnessy, Koen van Besien, and Francine Foss have served on advisory boards, received honoraria, or received research funding from Therakos.

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Shaughnessy, P., Bolwell, B., van Besien, K. et al. Extracorporeal photopheresis for the prevention of acute GVHD in patients undergoing standard myeloablative conditioning and allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 45, 1068–1076 (2010). https://doi.org/10.1038/bmt.2009.307

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