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Quality of Life

Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

Bone Marrow Transplantation volume 49, pages 704–708 (2014)Cite this article

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Abstract

There are few prospective studies evaluating the role of extracorporeal photopheresis (ECP) in chronic GVHD (cGVHD) and only occasional reports of the effect of ECP on patients’ quality of life (QoL). We report a single-centre prospective study of patients undergoing fortnightly ECP for moderate or severe cGVHD. Response was assessed after 6 months of treatment using NIH scoring criteria and reduction in immunosuppression. QoL assessments were undertaken at baseline and at 6 months using the chronic GVHD symptom scale (cGVHD SS) and dermatology life quality index (DLQI). An intention-to-treat analysis showed that 19/38 (50%) of patients had a complete or partial response. Twenty-seven out of 38 patients completed 6 months of ECP treatment and 70% (19/27) had a complete or partial response. Eighty per cent of patients who completed 6 months of ECP treatment had a reduction in immunosuppression dose. A subset of patients completed QoL questionnaires. Seventeen out of 18 patients (94%) showed an improvement in scores. The mean cGVHD SS and mean DLQI score were both significantly lower after 6 months of ECP (22 compared with 36, P=0.012 and 3.4 compared with 6.9, P=0.009, respectively). This study confirms that ECP can lead to objective clinical responses and, in addition, may lead to an improvement in QoL in cGVHD.

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References

  1. Edelson R, Berger C, Gasparro F, Jegasothy B, Heald P, Wintroub B et al. Treatment of cutaneous T-cell lymphoma by extracorporeal photochemotherapy. N Engl J Med 1987; 316: 297–303.

    Article  CAS  Google Scholar 

  2. Dignan FL, Greenblatt D, Cox M, Cavenagh J, Oakervee H, Apperley JF et al. Efficacy of bimonthly extracorporeal photopheresis in refractory chronic mucocutaneous GVHD. Bone Marrow Transplant 2012; 47: 824–830.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  4. Couriel DR, Hosing C, Saliba R, Shpall EJ, Anderlini P, Rhodes B et al. Extracorporeal photochemotherapy for the treatment of steroid-resistant chronic GVHD. Blood 2006; 107: 3074–3080.

    Article  CAS  Google Scholar 

  5. Jagasia MH, Savani BN, Stricklin G, Engelhardt B, Kassim A, Dixon S et al. Classic and overlap chronic graft-versus-host disease (cGVHD) is associated with superior outcome after extracorporeal photopheresis (ECP). Biol Blood Marrow Transplant 2009; 15: 1288–1295.

    Article  CAS  Google Scholar 

  6. Foss FM, DiVenuti GM, Chin K, Sprague K, Grodman H, Klein A et al. Prospective study of extracorporeal photopheresis in steroid-refractory or steroid-resistant extensive chronic graft-versus-host disease: analysis of response and survival incorporating prognostic factors. Bone Marrow Transplant 2005; 35: 1187–1193.

    Article  CAS  Google Scholar 

  7. Seaton ED, Szydlo RM, Kanfer E, Apperley JF, Russell-Jones R . Influence of extracorporeal photopheresis on clinical and laboratory parameters in chronic graft-versus-host disease and analysis of predictors of response. Blood 2003; 102: 1217–1223.

    Article  CAS  Google Scholar 

  8. Greinix HT, Socié G, Bacigalupo A, Holler E, Edinger MG, Apperley JF et al. Assessing the potential role of photopheresis in hematopoietic stem cell transplant. Bone Marrow Transplant 2006; 38: 265–273.

    Article  CAS  Google Scholar 

  9. Greinix HT, van Besien K, Elmaagacli AH, Hillen U, Grigg A, Knobler R et alUVADEX Chronic GvHD Study Group. Progressive improvement in cutaneous and extracutaneous chronic graft-versus-host disease after a 24-week course of extracorporeal photopheresis—results of a crossover randomized study. Biol Blood Marrow Transplant 2011; 17: 1775–1782.

    Article  Google Scholar 

  10. Flowers ME, Apperley JF, van Besien K, Elmaagacli A, Grigg A, Reddy V et al. A multicenter prospective phase 2 randomized study of extracorporeal photopheresis for treatment of chronic graft-versus-host disease. Blood 2008; 112: 2667–2674.

    Article  CAS  Google Scholar 

  11. Pavletic SZ, Martin P, Lee SJ, Mitchell S, Jacobsohn D, Cowen EW et alResponse Criteria Working Group. Measuring therapeutic response in chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. Response Criteria Working Group report. Biol Blood Marrow Transplant 2006; 12: 252–266.

    Article  Google Scholar 

  12. Lee S, Cook EF, Soiffer R, Antin JH . Development and validation of a scale to measure symptoms of chronic graft-versus-host disease. Biol Blood Marrow Transplant 2002; 8: 444–452.

    Article  Google Scholar 

  13. Finlay AY, Khan GK . Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210–216.

    Article  CAS  Google Scholar 

  14. Scarisbrick JJ, Taylor P, Holtick U, Makar Y, Douglas K, Berlin G et alPhotopheresis Expert Group. U.K. consensus statement on the use of extracorporeal photopheresis for treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease. Br J Dermatol 2008; 158: 659–678.

    Article  CAS  Google Scholar 

  15. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945–956.

    Article  Google Scholar 

  16. Lee SJ, Klein JP, Barrett AJ, Ringden O, Antin JH, Cahn JY et al. Severity of chronic graft-versus-host disease: association with treatment-related mortality and relapse. Blood 2002; 100: 406–414.

    Article  CAS  Google Scholar 

  17. Chiodi S, Spinelli S, Ravera G, Petti AR, Van Lint MT, Lamparelli T et al. Quality of life in 244 recipients of allogeneic bone marrow transplantation. Br J Haematol 2000; 110: 614–619.

    Article  CAS  Google Scholar 

  18. Fraser CJ, Bhatia S, Ness K, Carter A, Francisco L, Arora M et al. Impact of chronic graft-versus-host disease on the health status of hematopoietic cell transplantation survivors: a report from the Bone Marrow Transplant Survivor Study. Blood 2006; 108: 2867–2873.

    Article  CAS  Google Scholar 

  19. Kiss TL, Abdolell M, Jamal N, Minden MD, Lipton JH, Messner HA . Long-term medical outcomes and quality-of-life assessment of patients with chronic myeloid leukemia followed at least 10 years after allogeneic bone marrow transplantation. J Clin Oncol 2002; 20: 2334–2343.

    Article  CAS  Google Scholar 

  20. Lee SJ, Kim HT, Ho VT, Cutler C, Alyea EP, Soiffer RJ et al. Quality of life associated with acute and chronic graft-versus-host disease. Bone Marrow Transplant 2006; 38: 305–310.

    Article  CAS  Google Scholar 

  21. Pidala J, Kurland B, Chai X, Majhail N, Weisdorf DJ, Pavletic S et al. Patient-reported quality of life is associated with severity of chronic graft-versus-host disease as measured by NIH criteria: report on baseline data from the Chronic GvHD Consortium. Blood 2011; 117: 4651–4657.

    Article  CAS  Google Scholar 

  22. Syrjala KL, Langer SL, Abrams JR, Storer BE, Martin PJ . Late effects of hematopoietic cell transplantation among 10-year adult survivors compared with case-matched controls. J Clin Oncol 2005; 23: 6596–6606.

    Article  Google Scholar 

  23. Messina C, Locatelli F, Lanino E, Uderzo C, Zacchello G, Cesaro S et al. Extracorporeal photochemotherapy for paediatric patients with graft-versus-host disease after haematopoietic stem cell transplantation. Br J Haematol 2003; 122: 118–127.

    Article  CAS  Google Scholar 

  24. Smith EP, Sniecinski I, Dagis AC, Parker PM, Snyder DS, Stein AS et al. Extracorporeal photochemotherapy for treatment of drug-resistant graft-vs-host disease. Biol Blood Marrow Transplant 1998; 4: 27–37.

    Article  CAS  Google Scholar 

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Acknowledgements

We wish to thank Stephanie Lee and Andrew Finlay for their permission to use the cGVHD SS and DLQI questionnaires. JFA is grateful for the support from the NIHR Biomedical Research Centre funding scheme.

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Authors and Affiliations

  1. St John’s Institute of Dermatology, St Thomas’ Hospital, London, UK

    F L Dignan, S Aguilar & F J Child

  2. Section of Haemato-oncology, The Royal Marsden Hospital, Sutton, UK

    F L Dignan, B E Shaw & M N Potter

  3. University College London, Cancer Institute, London, UK

    F L Dignan & B E Shaw

  4. Department of Dermatology, Queen Elizabeth Hospital, Birmingham, UK

    J J Scarisbrick

  5. Department of Haematology, St Bartholomew’s Hospital, London, UK

    J Cavenagh

  6. Centre for Haematology, Imperial College, London, UK

    J F Apperley

  7. Department of Haematology, University College London, London, UK

    A K Fielding

  8. Department of Haematological Medicine, King’s College London Denmark Hill Campus, London, UK

    A Pagliuca & K Raj

  9. Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK

    D I Marks

  10. Department of Haematology, The Churchill Hospital, Oxford, UK

    A Peniket

  11. Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    C Crawley

  12. Department of Haematology, St George’s Hospital, London, UK

    M B Koh

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  1. F L Dignan
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Correspondence to F L Dignan.

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Competing interests

FLD has received research funding, honoraria and speakers’ fees from Therakos, a Johnson and Johnson company. BES, JFA and JJS have received honoraria and speakers’ fees from Therakos, a Johnson and Johnson company. FJC and KR have received honoraria from Therakos, a Johnson and Johnson company.

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Dignan, F., Aguilar, S., Scarisbrick, J. et al. Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD. Bone Marrow Transplant 49, 704–708 (2014). https://doi.org/10.1038/bmt.2014.21

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