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Graft-Versus-Host Disease

Efficacy of bimonthly extracorporeal photopheresis in refractory chronic mucocutaneous GVHD

Abstract

Extracorporeal photopheresis (ECP) has become a recognised treatment for steroid-refractory chronic GVHD (cGVHD), but the optimal frequency and duration of treatment are yet to be established. We report on 82 consecutive patients with mucocutaneous cGVHD who received a bimonthly regimen of ECP treatment for two consecutive days, which could be subsequently tapered to a monthly regimen depending on response. Patients were steroid-refractory, steroid-dependent or steroid-intolerant, and 29 (35%) had multiorgan involvement. The median duration of treatment was 330 days (42–987). The median number of ECP cycles was 15 (1.5–32). Response was assessed by clinical assessment and reduction in immunosuppression after 6 months. 69/82 (84%) had completed 6 months of ECP and 65/69 (94%) had 50% improvement in symptoms and signs of cGVHD. A total of 77% of patients who completed 6 months of ECP had a reduction in immunosuppression dose and 80% had decreased their steroid dose (27.5% stopped, 30% had 75% reduction, 17.5% had 50% reduction and 25% had <50% reduction). OS at 3 years from the start of ECP was 69%. This study reports the largest series of patients receiving bimonthly ECP treatment for cGVHD, and confirms that ECP allows successful reduction of immunosuppression.

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Acknowledgements

We would like to thank Dr Richard Szydlo for reviewing the statistical analysis and all the physicians in the transplant centres who referred patients to St Thomas’ Hospital. These included The Royal Marsden Hospital, Guy's Hospital, University College Hospital, Royal Free Hospital, Hammersmith Hospital, Churchill Hospital (Oxford), Bristol Royal Infirmary, Great Ormond Street Hospital, King's College Hospital, St Bartholomew's Hospital and University Hospital of Wales.

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Correspondence to F L Dignan.

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Competing interests

FLD has received research funding and honoraria from Therakos, a Johnson and Johnson company. JJS has received honoraria and speaker's fees from Therakos, a Johnson and Johnson company. BES has received research funding and speaker's fees from Therakos, a Johnson and Johnson company. JFA has received speaker's fees from Therakos, a Johnson and Johnson company. DG, MC, JC, HO, AF, AP, GM, KR, DIM, PA, AP, PM and MNP declare no conflict of interest. The sponsor had no involvement in study design, collection, analysis, interpretation of data, writing the report or in the decision to submit the paper for publication.

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Dignan, F., Greenblatt, D., Cox, M. et al. Efficacy of bimonthly extracorporeal photopheresis in refractory chronic mucocutaneous GVHD. Bone Marrow Transplant 47, 824–830 (2012). https://doi.org/10.1038/bmt.2011.186

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  • DOI: https://doi.org/10.1038/bmt.2011.186

Keywords

  • GVHD
  • extracorporeal photopheresis
  • chronic

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